Can Nurtec (rimegepant) be used to treat a migraine headache in an adult?

Can Nurtec Treat a Migraine Headache?

Yes, Nurtec (rimegepant) 75 mg is FDA-approved and highly effective for acute treatment of migraine headaches in adults, demonstrating statistically significant pain freedom and symptom relief at 2 hours compared to placebo. 1

Evidence for Acute Migraine Treatment

Rimegepant is positioned as a CGRP receptor antagonist with proven efficacy for acute migraine attacks:

• Pain freedom at 2 hours was achieved in 21.2% of patients taking rimegepant versus 10.9% on placebo (10.3% absolute difference, p<0.001) 1
• Most bothersome symptom freedom at 2 hours occurred in 35.1% versus 26.8% on placebo (8.3% absolute difference, p=0.001) 1
• Pain relief at 2 hours (reduction to mild or no pain) was achieved in 59.3% versus 43.3% on placebo (16.1% absolute difference, p<0.001) 1
• Sustained pain freedom from 2-48 hours occurred in 13.5% versus 5.4% on placebo (8.0% absolute difference, p<0.001) 1

Guideline-Based Treatment Algorithm

The 2025 American College of Physicians guidelines position rimegepant within a tiered approach: 2

First-line options:

• NSAIDs (aspirin, ibuprofen, diclofenac potassium) 2
• Acetaminophen (less effective, use only if NSAIDs contraindicated) 2

Second-line options:

• Triptans (all formulations have well-documented effectiveness) 2
• Triptan-NSAID combinations for enhanced efficacy 2

Third-line options (when triptans fail or are contraindicated):

• Rimegepant and other gepants (ubrogepant, zavegepant) 2
• Lasmiditan (ditan class, but causes driving impairment for 8 hours) 2

Specific Populations Where Rimegepant Excels

Triptan-unsuitable patients: A 2025 phase 4 trial specifically evaluated rimegepant in adults with documented triptan failure (intolerance, lack of efficacy, or contraindications): 3

• Pain relief at 2 hours: 55.9% versus 32.7% placebo (23.2% absolute difference, p<0.0001) 3
• Pain freedom at 2 hours: significantly superior to placebo (p≤0.0005) 3
• 84.9% had prior triptan lack of efficacy, 30.5% had triptan intolerance, 9.1% had contraindications 3

Safety Profile

Rimegepant demonstrates excellent tolerability: 1, 4

• No evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 4
• Adverse events occurred in similar rates to placebo (36% vs 36%) 5
• Most common side effects: upper respiratory tract infection, nasopharyngitis, sinusitis 5
• No severe or serious adverse events reported in the triptan-unsuitable population study 3

Dosing and Administration

• Dose: 75 mg orally disintegrating tablet (ODT) 1
• Timing: Take at onset of migraine attack with any pain intensity (mild to severe) 1
• Maximum frequency for acute treatment: One dose per day as needed 1
• Dual use consideration: If using rimegepant for both prevention (every other day) and acute treatment, maximum 18 doses in 30 days 5

Critical Pitfalls to Avoid

Medication overuse headache risk: 6

• Limit acute migraine-specific medications (including rimegepant) to fewer than 10 days per month 6
• Simple analgesics should be used fewer than 15 days per month 6

Timing considerations:

• Unlike triptans, rimegepant does not need to be taken only when pain is mild—it can be taken at any pain intensity 1
• Triptans should NOT be used during the aura phase, but rimegepant can be used once headache begins 2

Drug interactions:

• Safe to combine with SSRIs like fluvoxamine (no clinically relevant interactions) 6
• Can be continued perioperatively without discontinuation (unlike triptans or ergotamines) 7

Long-Term Safety Data

A 52-week open-label study in Chinese adults demonstrated: 8

• 84.6% of participants reported at least one treatment-emergent adverse event, but only 19.2% were considered rimegepant-related 8
• No rimegepant-related serious adverse events 8
• No treatment discontinuations due to rimegepant-related adverse events 8
• Mean reduction of 4.4 monthly migraine days across the treatment period 8

Concomitant Preventive Medication Use

Rimegepant can be safely used for acute treatment while taking preventive migraine medications: 9

• 13.5% of participants in a long-term study used concomitant preventive medications (most commonly topiramate at 26.3%) 9
• Safety profile remained favorable with similar adverse event rates whether or not preventives were used 9
• Serious adverse events occurred in only 4.5% of those using preventive medication versus 2.3% without preventives 9