Can Ubrelvy (ubrogepant) be used for migraine prevention in an adult patient with a history of migraines?

Ubrelvy (Ubrogepant) for Migraine Prevention

No, Ubrelvy (ubrogepant) is not indicated for migraine prevention and should not be used for this purpose. 1

FDA-Approved Indication

• Ubrelvy is FDA-approved exclusively for the acute treatment of migraine with or without aura in adults. 1
• The FDA label explicitly states: "UBRELVY is not indicated for the preventive treatment of migraine." 1
• This is a critical limitation that clinicians must understand—ubrogepant was developed, studied, and approved only as an abortive therapy, not as a preventive agent. 1

Guideline Recommendations on Prevention

Current clinical guidelines confirm there is insufficient evidence to support ubrogepant for migraine prevention:

• The 2023 VA/DoD guidelines state there is "insufficient evidence to recommend for or against rimegepant for the prevention of episodic migraine" (neither for nor against recommendation). 2
• While this guideline statement specifically addresses rimegepant (another gepant), the same principle applies to ubrogepant—the evidence base for gepants in prevention remains limited. 2
• The 2025 American College of Physicians guidelines do not recommend ubrogepant as a preventive agent. 2

Appropriate Use of Ubrelvy

For acute migraine treatment, ubrogepant has established efficacy:

• The 2023 VA/DoD guidelines provide a "weak for" recommendation for ubrogepant for the short-term (acute) treatment of migraine. 2
• The 2025 ACP guidelines consider ubrogepant as an option for moderate to severe acute episodic migraine in patients who do not tolerate or have inadequate response to combination therapy of a triptan with an NSAID or acetaminophen. 2
• Clinical trials demonstrated that 61.6% of patients achieved meaningful pain relief at 2 hours and 80.4% at 4 hours post-dose. 3

Evidence-Based Prevention Options

If your patient requires migraine prevention, consider these guideline-supported alternatives:

First-line preventive agents (strong or weak for recommendations):

• CGRP monoclonal antibodies: erenumab, fremanezumab, galcanezumab (strong for recommendation for episodic or chronic migraine). 2
• Atogepant: A gepant that IS approved for prevention (weak for recommendation for episodic migraine). 2
• Angiotensin-receptor blockers: candesartan or telmisartan (strong for recommendation). 2
• Topiramate: for episodic and chronic migraine (weak for recommendation). 2
• Valproate: for episodic migraine (weak for recommendation). 2
• Propranolol: for migraine prevention (weak for recommendation). 2
• Memantine: for episodic migraine (weak for recommendation). 2

Important distinction among gepants:

• Atogepant is the oral gepant with evidence supporting preventive use. 2
• Rimegepant has insufficient evidence for prevention. 2
• Ubrogepant is not indicated for prevention and lacks supporting data. 1

Clinical Considerations

• Patients should not take ubrogepant more than 8 times in 30 days, which further underscores its role as acute therapy only. 1
• If a patient is using ubrogepant frequently (approaching 8 attacks per month), this signals the need for preventive therapy, not increased acute medication use. 1
• Common pitfall: Confusing the gepant class—not all gepants have the same indications. Atogepant is for prevention; ubrogepant is for acute treatment only. 2, 1

Safety When Combined with Preventive Therapy

• Ubrogepant can be safely used as acute treatment in patients already on preventive therapy, including anti-CGRP monoclonal antibodies. 3
• Real-world data shows 72.7% treatment satisfaction when ubrogepant is used for acute attacks in patients on anti-CGRP monoclonal antibody prevention. 3