How to Use Zomig Nasal Spray
Zomig Nasal Spray should be used at the first sign of a migraine headache — but not during the aura phase (the early warning symptoms such as visual disturbances). Using it as soon as the headache starts gives the best chance of fully aborting the attack.
For cluster headaches, the spray should be used as soon as the attack begins.

Step-by-step application:

• Blow your nose gently if it is congested, then sit upright in a comfortable position.
• Remove the device from its protective packaging just before use.
• Hold the device between your index and middle fingers, with your thumb on the plunger underneath.
• Close one nostril by gently pressing the side of your nose (the side you are not spraying).
• Insert the nozzle into the open nostril, tilting your head slightly forward.
• Breathe in gently through the open nostril, and at the same time firmly press the plunger with your thumb until you hear a click — this releases the full dose.
• Keep your head tilted forward for around 10 seconds after the spray to allow the medication to absorb. Avoid sniffing or blowing your nose immediately afterwards.
• Discard the used device safely — each device is for single use only.

Important application tips:

• Use the spray in only one nostril — splitting the dose between both nostrils reduces absorption
• Do not tilt your head back — this may cause the spray to drip down the throat
• Do not press the plunger before insertion — this will release the dose into the air and waste it
• Avoid eating, drinking, or sniffing for a few minutes after use
• Rest in a quiet, dark room if possible to support recovery

Important Precautions
Cardiovascular safety: Like all triptans, zolmitriptan causes mild vasoconstriction, which is the basis of its action against migraine but also the reason it is contraindicated in people with cardiovascular disease. Before prescribing zolmitriptan to anyone over 40 or with cardiovascular risk factors, clinicians will typically assess:

• Blood pressure
• Personal and family cardiovascular history
• Cholesterol and diabetes status
• Smoking history
• If you experience chest pain, tightness, or breathlessness after using Zomig Nasal Spray — particularly if it is severe or persistent — seek urgent medical attention.

Drug interactions: Important interactions include:

• Monoamine oxidase inhibitors (MAOIs) — contraindicated; do not use within 2 weeks of stopping an MAOI
• Cimetidine — increases zolmitriptan levels significantly; maximum daily dose of 5mg if used together
• Fluvoxamine and quinolone antibiotics (such as ciprofloxacin) — can also increase zolmitriptan levels; maximum daily dose of 5mg
• Other triptans or ergotamine — do not combine within 24 hours
• Selective serotonin reuptake inhibitors (SSRIs) and SNRIs — risk of serotonin syndrome; use with caution
• Lithium — risk of serotonin syndrome
• St John's Wort — increases serotonin syndrome risk; avoid concurrent use
  Always inform your clinician about all medications and supplements you take.

Nasal conditions: Chronic nasal conditions — such as rhinitis, sinusitis, polyps, or recent nasal surgery — can affect absorption of the spray and may make it less reliable. Discuss with your clinician if you have any of these conditions.

Pregnancy and breastfeeding: Zomig Nasal Spray is not generally recommended in pregnancy or breastfeeding unless the potential benefit outweighs the risk. If used while breastfeeding, manufacturers advise discarding breast milk for 24 hours after a dose.

Driving and machinery: Zomig Nasal Spray can cause drowsiness or dizziness. Do not drive or operate machinery until you know how it affects you.

Alcohol: Alcohol can worsen migraines and may increase the risk of side effects. It is best avoided during a migraine attack, regardless of whether you have used Zomig.

Medication overuse headache (MOH): Frequent use of any acute migraine treatment — including triptans — can paradoxically lead to more headaches. Limit use to fewer than 10 days per month, and discuss preventive treatment options if your attacks are frequent.