Migraine Medication News

For many of the 39 million Americans who suffer from migraines, finding real, reliable relief is hit and miss. Medications called triptans are incredibly effective at stopping headaches for many people, and there are a variety of daily pills and monthly injections that people can take daily to prevent headaches. But more options are always better when it comes to a condition as life-disrupting and potentially debilitating as migraines, which is why it was great news that there’s now an entirely new type of medication, called a gepant, that’s highly effective at relieving migraine pain. Gepants were initially FDA-approved for acute migraine treatment (meaning to relieve pain once a migraine had begun) and now the FDA has approve Nurtec for preventive treatment too (meaning you can take Nurtec regularly to prevent migraines from even starting). Nurx medical advisor Dr. Charisse Litchman, neurologist and headache specialist, explains why this is a pretty huge deal.

What new options are available for migraine treatment today?

This is a very exciting era in migraine medicine. To go back a few years, since Imitrex, a triptan, came to market in 1991 there wasn’t a medication designed specifically to treat migraines until the monoclonal antibodies came out in 2018. Botox for migraine, which came out over ten years ago, also revolutionized migraine treatment, though it wasn’t initially designed to treat migraines. These monoclonal antibody treatments like Aimovig and Emgality truly advanced the field of headache medicine because they finally address the root cause, which is the release of the chemical CGRP. 

What do gepants offer compared to these treatments?

So Botox is still a wonderful option but it requires multiple injections by a medical provider every three months and can take as long as 6 to 9 months to achieve full benefit. The monoclonal antibodies have significant benefit for many patients and have a good safety profile — however, they require a monthly self-injection which is a deal breaker for some patients.  Further, there may be side effects associated with these injections and some patients experience a loss of benefit after about three weeks, even though the injections are monthly.  So, along came the gepants, Nurtec and Ubrelvy, which are truly a big deal. They block a chemical called CGRP and in that sense they’re similar to the way monoclonal antibodies like Aimovig and Emgality, but they inhibit CGRP without an injection. Nurtec, which is what Nurx delivers, is an orally dissolvable tablet that offers consistent benefit and is  good for people who suffer from nausea with their migraines, because it doesn’t require them to swallow a pill. 

What does the FDA’s new approval of Nurtec ODT (rimegepant) for migraine prevention mean for migraine treatment?

This is huge — we’ve been waiting for this for many years. It’s wonderful to have more treatment options, and the gepants — Nurtec and Ubrelvy — came out during the pandemic with indications for acute care but not for preventive. They added a tremendous tool for migraine doctors because they are wonderful acute treatments for people who don’t respond well to triptans, or who don’t take triptans because they are potentially dangerous for people with cardiovascular or cerebrovascular risk factors. 

Once we began prescribing Nurtec for acute treatment of migraines we saw that the length of benefit was lasting 48 hours. During the pandemic many people with migraines couldn’t get their Botox injections and there was a need for more migraine prevention options, so doctors began prescribing Nurtec off-label as a preventive, prescribing it to be taken every 48 hours, and it worked quite well. It has an incredible safety profile and this is great news that it can now be prescribed for both acute and preventive uses. For people with persistent migraines Nurtec can safely be combined with triptans and many headache specialists use them in conjunction with monoclonal antibodies and Botox. It’s always wonderful to have more tools in the migraine treatment toolbox!

About the Author

Charisse Litchman MD, FAHS is a neurologist, headache specialist, and medical advisor to Nurx. She received her undergraduate degree at Wesleyan University and her medical degree at Yale School of Medicine. After completing her internship at Yale New Haven Hospital, she completed her neurology residency at Cornell-New York Hospital. She began a solo private practice in general neurology and became board certified in headache medicine in 2008. A former Assistant Professor of Clinical Neurology at Yale School of Medicine, Charisse has published articles in headaches and multiple sclerosis and edited the first textbook on a rare soft tissue tumor.  She has earned a certificate in Medical Editing and Writing from the University of Chicago. Charisse has three children and lives in Connecticut with her husband Mark and her two dogs.

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