Melissa Yokoyama, PharmD Candidate

Migraines are a chronic neurobiological condition that are among the most common disabling health conditions affecting people worldwide. This disorder peaks in prevalence between 25 and 55 years of age and the patient population is approximately 75% female.

The current acute migraines treatments have shown efficacy and safety , however, approximately one-third of people do not respond, cannot use these options due to contraindications, or report dissatisfaction in therapy. Triptans are considered the gold standard for the acute treatment of moderate to severe migraine, with strong evidence in support of their efficacy.

However, triptans are not efficacious in all patients and are contraindicated in people with coronary artery disease, peripheral vascular disease, or uncontrolled hypertension. They are also not recommended in patients with risk factors for undiagnosed coronary artery disease.

With this barrier to triptans in certain populations, researchers decided to explore classes of medications that could be used in these target patients and for people with these contraindications. With a high demand for new treatment options, ubrogepant (Ubrelvy, Allergan), rimegepant (Nurtec, Biohaven), and lasmiditan (Reyvow, Elli Lilly) came to market.

 details the drug information about each medication and vital data for prescribing these new formulations.

calcitonin gene-related peptide receptor antagonist

A second dose may be administered at least 2 hours after the initial dose.

Safety of treating more than 8 migraines in a 30-day period has not been established.

Onset: 1 hour (maximum efficacy seen between 3-8 hours)

Recommended dose: 50 mg or 100 mg or 200 mg

Safety of treating more than 4 migraines in a 30-day period has not been established.

≥ 5%: dizziness, fatigue, paresthesia, numbness and sedation

: Advise patients not to drive or operate machinery until at least 8 hours after taking each dose

The safety of treating more than 15 migraines in a 30-day period has not been established

Onset: <2 hours (migraine pain free as early as 1 hour and MBS-free as early as 0.5 hours)

Time to Peak: 1.5 hours (delayed 1 hour following high fat meal)

Articles

The current acute treatments for migraines have shown efficacy and safety, however, approximately one-third of people do not respond, cannot use these options due to contraindications, or report dissatisfaction in therapy.