If you suffer from migraines, you're likely already familiar with triptans. Sumatriptan is a popular choice, but there are alternatives. Zolmitriptan (Zomig) and rizatriptan (Maxalt) both belong to the same drug class and work in a similar way, but they differ in dose, formulation and how quickly they tend to take effect. This guide compares zolmitriptan vs rizatriptan across onset, side effects and the details that can make one a better fit than the other.
We've already covered how sumatriptan compares to rizatriptan on the Health Hub. This article aims to provide with more detail about the other triptan commonly available (zolmitriptan) and how it compares to rizatriptan.
How do triptans work?
Triptans are a class of medicines used to treat a migraine attack once it has started, rather than to prevent one.1 They work by acting on serotonin (5-HT1B/1D) receptors, which narrows blood vessels in the brain and reduces the release of pain-signalling chemicals around the trigeminal nerve.2 Both zolmitriptan and rizatriptan work this way, which is why they tend to cause similar side effects. Where they really differ is in dosing, how they're metabolised and the formats available in the UK.
Timing matters more than most people expect. Both medicines are meant to be taken during the headache phase of an attack, rather than during the warning "aura" that some people experience beforehand, and both tend to work best when taken as early as possible once the headache itself has set in.2 Taking a triptan too early, before the headache has properly started, hasn't been shown to prevent it developing.
Zolmitriptan (Zomig) vs rizatriptan (Maxalt): the key differences
Both medicines are taken at the first sign of a migraine attack, but the dose, redosing rules and available formats are different. Both are licensed for adults - a GP will advise separately on suitability for anyone under 18.
Zolmitriptan (Zomig)
The standard dose of zolmitriptan is 2.5mg, which can be increased to 5mg for future attacks if 2.5mg isn't effective enough, up to a maximum of 10mg in 24 hours.2 It's available as a standard tablet, an orodispersible tablet that dissolves on the tongue without needing water, and a nasal spray option, which is useful if nausea or vomiting make swallowing tablets difficult.3
Food doesn't affect how zolmitriptan tablets are absorbed, so you don't need to time doses around meals.2 Zolmitriptan is also licensed for migraine associated with the menstrual cycle, not just migraine with or without aura.2
Rizatriptan (Maxalt)
The standard dose of rizatriptan is 10mg (reduced to 5mg if you're also taking propranolol), and it's taken as a tablet or as Maxalt Melt, a wafer that dissolves on the tongue in a similar way to zolmitriptan's orodispersible version.4 Unlike zolmitriptan, rizatriptan isn't currently available as a nasal spray in the UK, so it may not be the best option if you tend to get very nauseous or feel sick when a migraine hits.
Taking it with food delays absorption by around an hour, so it tends to work best on an empty stomach. A second dose can be taken after at least 2 hours if the migraine hasn't fully cleared, up to a maximum of 2 doses in 24 hours. If the first dose doesn't work at all, taking a second dose for the same attack isn't recommended, as trial data doesn't show it adds any benefit.4
Which works faster?
A randomised, placebo-controlled trial of 766 patients compared rizatriptan 10mg with zolmitriptan 2.5mg head to head.5 Rizatriptan tended to relieve pain slightly sooner, with more patients pain-free at 2 hours (43% vs 36%) and fewer reporting nausea or sensitivity to light at that point.5
More patients on rizatriptan also reported a return to normal function by 2 hours (45% vs 37%).5 Headache relief at 2 hours, however, was similar between the two medicines (71% vs 67%), and recurrence of the headache within 24 hours was almost identical (28% for rizatriptan, 29% for zolmitriptan, compared with 26% on placebo).5 In practice, the difference between standard tablets is modest, and both were well tolerated in the trial.5
Zomig's nasal spray is the fastest-acting option of the medicines discussed here, with the first signs of relief apparent within 15 minutes.3 This can matter if your migraines come on quickly or you're prone to vomiting early in an attack, since swallowed tablets have less chance to be absorbed properly before they take effect.
What are the side effects?
Because zolmitriptan and rizatriptan work in the same way, their side effect profiles are similar:
- Fatigue or drowsiness - common with both medicines, particularly in the first hour after dosing.5
- Dizziness - reported with both. Avoid driving or operating machinery until you know how the medicine affects you.5
- Tightness or pressure in the chest, throat or jaw - a known effect of taking triptans, caused by mild narrowing of blood vessels. Tell your pharmacist or GP if this happens.2
- Nausea - can occur with either medicine, though it appeared less often with rizatriptan in trial data.5
- Unusual taste - reported specifically with zolmitriptan nasal spray, as the dose passes through the back of the throat.3
Neither medicine should be taken within 24 hours of another triptan or an ergotamine-type medicine, or if you have a history of heart attack, stroke, uncontrolled high blood pressure or other significant cardiovascular disease.2,4 Both should also be used cautiously alongside certain antidepressants, and your medical assessment will check for interactions when the medicine is prescribed or dispensed. If you're pregnant, trying to conceive or breastfeeding, speak to your GP before taking either medicine, as the safety data for each is limited.2,4
Which should you choose?
For most people, the choice comes down to practical factors rather than efficacy, since the two medicines perform similarly overall:
- If you're often sick or struggle to swallow tablets during an attack, Zomig nasal spray offers a non-oral option that rizatriptan doesn't.
- If you take propranolol for migraine prevention or another condition, your GP will usually prescribe the lower 5mg dose of rizatriptan, since the two interact. Zolmitriptan doesn't carry the same interaction, so a standard dose can typically still be used.4
- If you tend to eat before a migraine sets in, zolmitriptan's absorption isn't affected by food, whereas rizatriptan's is delayed by around an hour.2,4
- If cost matters, standard rizatriptan and zolmitriptan tablets are usually similarly priced. The nasal spray and orodispersible formats tend to cost more.
If you've tried one triptan without much success, switching to the other is a common next step, and it's worth discussing with our team or your GP which of these factors matter most for your migraines.
When should you seek medical advice?
Speak to a pharmacist or GP if:
- You need to use a triptan more than 10 days a month, as this can lead to medication overuse headache
- Your migraines change in pattern, become more frequent, or you develop a new type of headache
- You experience chest pain, tightness or shortness of breath after taking either medicine
- Neither zolmitriptan nor rizatriptan controls your migraine symptoms within a couple of attacks
Frequently asked questions
How long does rizatriptan take to work?
Rizatriptan tablets start relieving pain within about an hour for most people, with effects building over the following hour or two. Taking it on an empty stomach helps, since food can delay absorption by around an hour.
How long does zolmitriptan take to work?
Zolmitriptan tablets show noticeable relief from around an hour after dosing, with effects continuing to build over the next few hours. The nasal spray version works faster, with early signs of relief within about 15 minutes.
Is zolmitriptan or rizatriptan stronger?
Neither is "stronger" in a straightforward sense. Trial data shows rizatriptan may relieve pain slightly sooner for some people, but headache relief at 2 hours is very similar between the two, and side effects are broadly comparable.
Can you take zolmitriptan and rizatriptan together?
No. You should not take two different triptans within 24 hours of each other. If one isn't working well enough, speak to your GP or pharmacist about switching rather than combining them.
Is zolmitriptan or rizatriptan available as a nasal spray?
Zolmitriptan is available as a nasal spray (Zomig Nasal Spray) as well as tablets. Rizatriptan is only available in the UK as a tablet or as MAXALT MELT, a wafer that dissolves on the tongue.
Can you take zolmitriptan or rizatriptan while pregnant or breastfeeding?
Speak to your GP before taking either medicine if you're pregnant, trying to conceive or breastfeeding. Safety data for both is limited, so a healthcare professional needs to weigh this up with you directly.
References
- The Migraine Trust. Triptans. migrainetrust.org
- Electronic Medicines Compendium. Zomig Tablets 2.5mg SmPC. eMC; 2026. medicines.org.uk/emc
- Electronic Medicines Compendium. Zolmitriptan Grunenthal 5mg Nasal Spray SmPC. eMC; 2026. medicines.org.uk/emc
- Electronic Medicines Compendium. Maxalt 5mg and 10mg Tablets SmPC. eMC; 2026. medicines.org.uk/emc
- Pascual J, Vega P, Diener HC, et al. Comparison of rizatriptan 10 mg vs. zolmitriptan 2.5 mg in the acute treatment of migraine. Cephalalgia. 2000;20(5):455-461. doi:10.1046/j.1468-2982.2000.00069.x
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.