Suzetrigine for Migraine Treatment
Direct Answer
Suzetrigine is not recommended for migraine treatment, as it is not included in current evidence-based guidelines for acute or preventive migraine therapy.
Evidence-Based Treatment Recommendations
The most recent and authoritative guidelines for migraine management do not mention suzetrigine as a treatment option. The 2025 American College of Physicians clinical guideline provides clear recommendations for pharmacologic treatment of acute episodic migraine 1:
First-Line Acute Treatment Options
For moderate to severe migraine: Combination therapy of a triptan plus an NSAID is strongly recommended for nonpregnant adults who do not respond adequately to NSAIDs alone 1
Alternative combination: A triptan plus acetaminophen can be used for patients who do not respond adequately to acetaminophen monotherapy, though this carries a conditional recommendation with lower-certainty evidence 1
Monotherapy options: NSAIDs, acetaminophen, and triptans remain the cornerstone of acute migraine treatment 2
Newer Agents with Evidence Support
The 2025 guidelines acknowledge newer therapeutic classes that have emerged as alternative treatments 1:
CGRP antagonists (gepants): These are supported by quality evidence for second-line use and have the advantage of no vascular contraindications 2
Selective 5-HT1F agonists (ditans): Also supported for second-line use, though cost and adverse effects may limit their use 2
Why Suzetrigine Is Not Recommended
Current evidence-based guidelines from the American College of Physicians (2025) and American Academy of Family Physicians comprehensively review pharmacologic treatments for migraine but do not include suzetrigine 1, 2
The systematic approach to selecting interventions for migraine treatment is based on availability in the United States, evidence supporting efficacy compared to placebo in published systematic reviews, and alignment with defined eligibility criteria 1
Suzetrigine does not appear in the evidence hierarchy for migraine treatment, which includes NSAIDs, triptans, ergot alkaloids, gepants, and ditans 1, 2
Clinical Algorithm for Acute Migraine Treatment
Step 1: Start with NSAIDs (such as naproxen) or acetaminophen for mild to moderate migraine 1
Step 2: If inadequate response, add a triptan (such as sumatriptan or rizatriptan) to the NSAID or acetaminophen 1
Step 3: For patients with contraindications to triptans (cardiovascular disease, uncontrolled hypertension), consider gepants or ditans as second-line agents 2
Step 4: Antiemetics and ergot alkaloids serve as second-line agents for refractory cases 2
Medications to Avoid
- Opioids and butalbital-containing medications are not recommended unless all other options have been ineffective 2
Important Caveats
Patient preference data show that individuals probably prioritize oral medications over other routes of administration when effectiveness is similar 1
Cost considerations are significant, with newer agents like gepants having substantially higher costs (approximately $5,994 annually) compared to traditional therapies like triptans and NSAIDs (approximately $500 annually) 1
Approximately 40% of patients who respond to triptans experience headache recurrence within 24 hours, which can be effectively treated with an additional dose 3, 4