Imagine a life free from the debilitating grip of migraines. Migraines can wreak havoc on your life, and unfortunately, they are very common. Around 16% of adults have experienced a migraine or severe headache. Migraines are one of the leading causes of disability worldwide, leading to significant economic impact in addition to its impact on the individual. 

The past several years have brought many advancements in therapy for treating migraines, including Rimegepant. These new advancements offer hope for effective relief in a population that has struggled to find reprieve from this debilitating illness. 

This article dives into what makes Rimegepant revolutionary, it’s benefits, how it works, and what patients and healthcare providers need to know.

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Understanding Rimegepant

Rimegepant is a newer medication for the treatment of migraines, but what exactly is it, and how does it work?

What is Rimegepant?

Rimegepant is marketed under the brand name Nurtec®. This medication is in a class of medications called calcitonin gene-related peptide receptor (CGRP) antagonists. Rimegepant is used to prevent migraines and is a rescue medication for breakthrough migraines. It can be used for people with or without an aura.

Rimegepant was approved by the U.S. Food and Drug Administration (FDA) for the acute treatment of migraines in 2020 and got its preventative indication in 2021. The European Union approved the medication for both indications in 2022. Rimegepant is the first medication to be approved for both preventive treatment and breakthrough. 

The approval of Rimegepant for migraines was the culmination of several years of research as Biohaven, the company that brought Rimegepant to market, began enrolling patients in Phase 3 clinical trials in mid-2017.

How Does Rimegepant Work?

Rimegepant is one of several CGRP receptor antagonists on the market. CGRP is a protein that can cause inflammation in the brain covering when released. CGRP receptor agonists prevent CGRP from being able to bind to their receptors, thereby decreasing inflammation.

Benefits of Rimegepant

Rimegepant has several benefits.

Efficacy in Treating Acute Migraines

A 2020 review study in Frontiers in Pharmacology found a significant improvement in pain levels from 2 hours to 48 hours after taking the medication. There was over a 50% improvement in freedom from pain when compared to placebo. 

Another study from 2024 showed Rimegepant to have greater efficacy for the most bothersome migraine symptoms when compared to Lasmiditan and Urogepant.

Convenience and Dual Use

Rimegepant is unique because in addition to its use in the treatment of acute migraine symptoms, it can also be used as a preventative medication. To prevent migraines, Rimegepant is dosed every other day. Rimegepant is currently the only medication approved by the FDA for both the prevention of migraines and the treatment of acute migraine.

Dosage and Administration

Rimegepant is dosed differently depending on whether it is taken for prevention or for an acute migraine.

Recommended Dosage

Rimegepant is administered as a 75mg oral dissolving tablet (ODT). For the prevention of migraines, you take Rimegepant every other day. An additional 3 tablets can be taken per month for acute migraine attacks. 

According to the manufacturer, 18 doses per 30 days is the maximum recommended dose. They also do not recommend taking more than 1 tablet in 24 hours.  

Tips for Effective Use

Rimegepant comes in a sealed foil packet. Don’t open the tablet until it is time to take it because it dissolves when exposed to moisture.  The medication dissolves when placed under your tongue. 

For the prevention of migraine, take it every other day or as directed by your healthcare provider. For an acute migraine, you should take the medication as soon as you have migraine symptoms. The medication works within 2 hours. 

Potential Side Effects

Like any medication, Rimegepant has potential side effects. 

Common Side Effects

The most common side effect of Rimegepant for both treatment of acute migraine and migraine prevention is nausea. Other potential side effects include:

• Indigestion
• Belching
• Heartburn
• Stomach discomfort

These are not the only side effects associated with Rimegepant, but they are the most common. These side effects don’t usually cause any long-term health problems. There is also the potential for more serious side effects, though these are rare.

Rare But Serious Risks

In addition to the more common side effects, Rimegpant has the potential to cause more serious side effects. 

• Fever
• Hives
• Rash
• Redness of the skin (especially the ears)
• Fatigue
• Weakness
• Trouble breathing
• Difficulty swallowing
• Mild liver abnormalities

Fortunately, these side effects are rare. But if you experience these symptoms, talk with your healthcare provider.

Mitigating Risks

Rimegepant is generally well-tolerated and doesn’t cause significant side effects. However, it is important to monitor how you are feeling when starting a new medication. If you experience shortness of breath, difficulty swallowing, severe fatigue, hives, rashes, or redness of the skin, you should talk to your healthcare provider and seek medical attention. 

Nausea is the most common side effect and may be reduced by eating smaller meals more frequently or avoiding spicy foods. It may also be helpful to drink fluids in small amounts and adjust the timing of your dose.

Rimegepant vs. Other Migraine Medications

So, how does Rimegepant compare to other medications used to treat migraines? With the development of Rimegepant and other CGRP inhibitors, there has been an influx of new medications available to treat migraine. Let’s compare some of them.

Comparison with Triptans and Other CGRP Inhibitors

There are three primary classes of medications that are indicated to specifically treat migraines: CGRP receptor inhibitors, monoclonal antibodies, and triptans. Other medications, such as ibuprofen or acetaminophen, are sometimes used to treat migraines as well. 

CGRP receptor inhibitors work differently than triptans. While CGRP receptor inhibitors decrease inflammation by blocking the CGRP receptors, triptans dilate the arteries in the brain, inhibit certain neurotransmitters in the trigeminal nerve, and decrease the release of certain proteins from the trigeminal nerve.

Who Should Consider Rimegepant?

Rimegepant is unique among migraine treatment options because it can be used as both a preventative medication as well as a rescue medication for acute migraine attacks. People who are looking for one medication to help with both indications may want to consider this medication as an option. Rimegepant may also be an option for people who haven’t gotten relief from other medications. 

There are no official contraindications to Rimegepant other than an allergy to the medication, but people with vascular diseases may want to use the medication with caution since Rimegepant can affect the vascular system. 

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Key Takeaways

• Rimegepant is the only migraine medication approved for both migraine prevention and treatment of acute migraine
• Rimegepant is taken every other day for migraine prevention, and a total of 18 doses can be taken in 30 days
• Rimegepant has very few contraindications
• Rimegepant is generally well-tolerated with few side effects

Finding the right migraine medication can be a challenge, and it's important to consult with your healthcare provider to determine which medication is best for your unique situation. If you suffer from migraines, talk to your healthcare provider about whether Rimegepant may be appropriate to give you back your life.