From the Guidelines
Abortive medications for migraine, such as gepants (e.g., ubrogepant and rimegepant) and ditans (e.g., lasmiditan), are effective alternatives to triptans, with a "weak for" recommendation for ubrogepant and rimegepant, and a "neither for nor against" recommendation for lasmiditan 1. When considering abortive therapies for migraine, the goals include rapid and sustained alleviation of pain and restoration of function.
- Gepants, such as ubrogepant (Ubrelvy, 50-100mg) and rimegepant (Nurtec ODT, 75mg), work by blocking CGRP receptors and can be taken at the onset of migraine with repeat dosing as needed per prescription.
- Ditans, like lasmiditan (Reyvow, 50-200mg), target 5-HT1F receptors and are particularly useful for patients with cardiovascular contraindications to triptans.
- For mild to moderate migraines, NSAIDs such as ibuprofen (400-800mg), naproxen sodium (500-550mg), or aspirin (900-1000mg) can be effective when taken early, with aspirin–acetaminophen–caffeine having a "strong for" recommendation 1.
- Combination medications like acetaminophen/aspirin/caffeine (Excedrin Migraine) work through multiple mechanisms to relieve pain.
- Antiemetics including metoclopramide (10mg), prochlorperazine (10mg), or chlorpromazine can address both nausea and migraine pain.
- Neuromodulation devices provide non-medication options, although the evidence for their use is limited 1. These alternatives are particularly valuable for patients who don't respond to triptans, have contraindications, or experience unacceptable side effects.
- For optimal results, abortive medications should be taken at the earliest signs of migraine, and patients should limit use to 2-3 days per week to prevent medication overuse headaches.
- Greater occipital nerve blockade received a "weak for" recommendation for the abortive treatment of migraine, with balanced risks and benefits 1.
From the FDA Drug Label
Other Drug-Drug Interaction Evaluations: No significant pharmacokinetic interactions were observed for either ubrogepant or co-administered drugs when UBRELVY was administered with ... sumatriptan,
- Other abortive medications for migraine include:
- Sumatriptan
- Atogepant
- Erenumab
- Galcanezumab 2
From the Research
Abortive Medications for Migraine
Other abortive medications for migraine include:
- Lasmiditan, which is the first in its class approved for acute migraine treatment and exerts its therapeutic effect through agonism at the 5-HT1F receptor without inducing vasoconstriction 3
- Ubrogepant, a selective CGRP antagonist that has been evaluated in large short- and long-term Phase 2 and 3 clinical trials for clinical efficacy and safety as an acute migraine medication 4, 5
- Triptans, such as eletriptan, sumatriptan, almotriptan, naratriptan, frovatriptan, rizatriptan, and zolmitriptan, which are serotonin 5-HT1B/1D receptor agonists that effectively relieve the pain, disability, and associated symptoms of migraine 6
- Rimegepant and Nurtec, which are also CGRP receptor antagonists mentioned in the study of lasmiditan 3
Mechanism of Action
These medications work through different mechanisms, including:
- Agonism at the 5-HT1F receptor (lasmiditan) 3
- Antagonism of the CGRP receptor (ubrogepant, rimegepant, and Nurtec) 3, 4, 5
- Agonism at the serotonin 5-HT1B/1D receptor (triptans) 6
Clinical Use
These medications are used for the acute treatment of migraine attacks, and the choice of medication depends on various factors, including the patient's medical history, presence of comorbidities, and previous response to treatment 3, 4, 6, 5