A migraine is a recurrent neurological condition characterized by headache attacks that present as unilateral, throbbing pain. Migraine attacks are the leading cause of disability in individuals younger than 50 years  and predominantly affect women. The FDA has not approved any medication that treats both acute and preventative treatment of migraine.1

Most oral treatments for migraine prevention, such as β blockers, antiepileptic drugs, and tricyclic antidepressants. have noteworthy adverse effect profiles and need daily administration.1 Because of these factors, more than 80% of patients stop taking their prophylactic medications within 1 year.2

The neuropeptide calcitonin gene-related peptide (CGRP) plays a central role in the underlying pathology of migraine. CGRP is the prominent neurotransmitter that precipitates a migraine and increases during an attack.3 Rimegepant is a CGRP antagonist that is only FDA-approved for acute migraine treatment.1 Due to the lack of prophylactic migraine medications, investigators compared the efficacy of rimegepant with that of placebo for migraine prevention.

At the start of the trial, the investigators randomized adults with at least a 1-year history of migraine to oral rimegepant 75 mg or placebo every other day for 12 weeks. They used an interactive web response system.1 

The study found that rimegepant was superior to placebo at change in the mean number of migraine days per month. Rimegepant reduced moderate or severe migraine days per month and total migraine days per month over placebo. As a result, the CGRP receptor antagonists may provide a targeted novel approach to migraine prevention.1

Findings from the study also showed a favorable safety and tolerability profile with rimegepant. Reasons individuals could benefit using rimegepant include a low adverse effect profile, oral administration, and a short half-life of 11 hours.1

The investigators concluded that use of rimegepant for acute and preventive treatment of migraine might reduce the overall burden of illness associated with the condition. This idea merits further investigation, they said.1
 
Raquel S. Mateus is a 2021 PharmD Candidate at the University of Connecticut in Storrs.


REFERENCES
  1. Croop R, Lipton RB, Kudrow D, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. Lancet. 2021 Jan 2;397(10268):51-60. doi: 10.1016/S0140-6736(20)32544-7
  2. Bucklan J, Ahmed Z. CGRP Antagonists for Decreasing Migraine Frequency: A Primer. Consult QD. Published August 3, 2020. Accessed January 12, 2021. https://consultqd.clevelandclinic.org/cgrp-antagonists-for-decreasing-migraine-frequency-a-primer/
  3. Durham PL, Vause CV. Calcitonin gene-related peptide (CGRP) receptor antagonists in the treatment of migraine. CNS Drugs. 2010 Jul;24(7):539-48. doi: 10.2165/11534920-000000000-00000