New Treatment Option for Acute Migraine Headaches

Published November 24th, 2020 by Dr. Dylan Kakos, PharmD
Fact Checked by
Chris Riley
Medically Reviewed:
Camille Freking
Updated Date: Feb 2nd, 2021

If you’re reading this, you or someone you know likely suffers from migraine headaches. Migraines are common in the United States, where it’s estimated they affect 12% of the population. 

Currently, we don’t have a cure for migraine headaches. Therefore, doctors rely on a combination of different medications to decrease the chance of getting a migraine and treat the migraine attack if it occurs. Migraine headaches can lead to stroke, seizures, pain, and mental health issues like depression and bipolar disorder if not treated. 

In recent years, scientists have started to understand better what triggers migraine attacks, leading to the discovery of new medications that may help reduce migraine symptoms and help people recover faster. 

The Food and Drug Administration (FDA) recently approved a new medication called rimegepant (NurtecTM ODT) to treat migraine attacks. Let’s explore the science behindrimegepant!

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What is Acute Migraines Headaches?

Acute migraine headaches are intense headaches that usually occur on one side of the head. They can last from hours to days while making it very difficult to do daily activities. 

Signs and symptoms of an acute migraine headache include:

  • Aura – a bright spot in the eyes, a spot of vision loss, irritability, ringing in the ears, tingling, or numbness
  • Nausea
  • Vomiting
  • Sensitivity to light and sound 
  • Throbbing head pain 
  • Weakness 
  • Trouble speaking 

The research shows that migraines occur most often in people aged 30-39, that genetics is one of the main risk factors, and that women are three times more likely to be affected than men. 

What Can Trigger an Acute Migraine Headache?

Many different factors can trigger a migraine headache. Since everyone responds to different triggers, it’s important to try and avoid triggers that you know might cause you to have an acute migraine attack. Some well-known triggers are listed in the table below.

Hormonal changes in women

Stress

Bright lights

Weather changes

Sleep changes

Medications

Foods

Strong smells

What is Rimegepant?

Rimegepant (NurtecTM ODT) is a medication that belongs to a new class of migraine drugs called calcitonin gene-related peptide (CGRP) blockers. CGRP is a molecule that gets released during a migraine attack and has been shown to increase pain and inflammation. 

Rimegepant works by blocking the CGRP molecule during a migraine attack to reduce pain and other migraine symptoms.  

Rimegepant is an oral tablet taken once when you start to feel signs of an acute migraine headache. ODT means that it is an orally disintegrating tablet, meaning it dissolves in your mouth quickly to start working faster. 

What Does the Data Say?

The key study that resulted in rimegepant being approved compared the migraine medication to a placebo group during an acute migraine headache. The study looked at freedom from pain and freedom from most bothersome symptoms 2 hours after receiving a dose. 

The results showed that rimegepant provided significant freedom from pain and the most bothersome symptoms. They also showed that the medication effect could last for up to 48 hours. 

The most common side effects were nausea, urinary tract infections, rash, and trouble breathing. If you experience a rash or difficulty breathing while on rimegepant, you should contact your doctor immediately, as this may be an allergic reaction. 

rimegepant may interact with other medications, so it’s important to make sure that your doctor knows every medication you are taking beforehand. Rimegepant may not be the best treatment for everyone, so be sure to talk to your doctor or pharmacist to see if it may work for you. 

The Takeaway 

Acute migraine headaches are among the most common debilitating conditions and could lead to severe complications if left untreated. Because migraines can last multiple days, it can be challenging to perform activities of daily living comfortably. 

rimegepant is a medication that was recently approved by the FDA to treat acute migraine headaches. It works by blocking the CGRP molecule to decrease pain and other migraine-related symptoms. Make sure to speak with your doctor or pharmacist about the best way to manage your migraine headaches. 

Reference List

  1. Burch RC, Buse DC, Lipton RB. Migraine: Epidemiology, Burden, and Comorbidity. Neurol Clin. 2019;37(4):631-649. doi:10.1016/j.ncl.2019.06.001
  2. Puledda F, Messina R, Goadsby PJ. An update on migraine: current understanding and future directions. J Neurol. 2017;264(9):2031-2039. doi:10.1007/s00415-017-8434-y
  3. Mayo Clinic. Migraine. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201. Last Reviewed January 2020. Accessed 8 October 2020. 
  4. Sutherland HG, Griffiths LR. Genetics of Migraine: Insights into the Molecular Basis of Migraine Disorders. Headache. 2017;57(4):537-569. doi:10.1111/head.13053
  5. Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017;16(1):76-87. doi:10.1016/S1474-4422(16)30293-9
  6. Nurtec ODT (rimegepant) [prescribing information]. New Haven, CT: Biohaven Pharmaceuticals Inc; March 2020.
  7. Croop R, Goadsby PJ, Stock DA, et al. Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial. Lancet. 2019;394(10200):737-745. doi:10.1016/S0140-6736(19)31606-X

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