Does Nurtec Work Only for Migraine?
Yes, Nurtec (rimegepant) is FDA-approved exclusively for migraine—both for acute treatment of migraine attacks and for preventive treatment of episodic migraine in adults—and should not be used for other headache types. 1
FDA-Approved Indications
Rimegepant is approved for two specific migraine indications:
- Acute treatment of migraine (with or without aura) in adults, administered as a single 75 mg orally disintegrating tablet taken as needed 1, 2
- Preventive treatment of episodic migraine in adults, administered as 75 mg every other day 1, 2
The drug demonstrated statistically significant efficacy in phase III trials, achieving 21.2% pain freedom at 2 hours (versus 10.9% for placebo) for acute treatment, and reducing monthly migraine days by an additional 0.8 days compared to placebo for prevention. 1
Why Rimegepant Does Not Work for Non-Migraine Headaches
Rimegepant is a calcitonin gene-related peptide (CGRP) receptor antagonist that specifically targets the pathophysiology of migraine. 2, 3 The CGRP pathway is uniquely activated during migraine attacks but is not the primary mechanism in other headache disorders such as tension-type headache, cluster headache, or secondary headaches (e.g., sinus headache). 4
- For tension-type headache, the 2024 VA/DoD guidelines recommend ibuprofen 400 mg or acetaminophen 1000 mg as first-line therapy—not CGRP antagonists. 4, 5
- For cluster headache, galcanezumab (a different CGRP-targeting agent) has some evidence for episodic cluster headache, but rimegepant has no established role. 4
- Using rimegepant for non-migraine headaches constitutes off-label use lacking supporting evidence and exposes patients to higher cost and potential adverse effects without proven benefit. 5
Diagnostic Reconsideration When Rimegepant Appears Effective
If a patient diagnosed with a non-migraine headache experiences relief after rimegepant, the diagnosis should be reconsidered because the response suggests the headache may in fact be migraine. 5
- Migraine can present atypically—without classic aura, throbbing pain, or unilateral location—and may be mistaken for tension-type or "sinus" headache. 5
- Many patients labeled as having "sinus headache" actually have migraine, which can present with facial pressure and nasal congestion. 5
Evidence-Based Alternatives for Non-Migraine Headaches
For headaches that are truly not migraine:
- Tension-type headache: Ibuprofen 400 mg or acetaminophen 1000 mg for acute episodes; amitriptyline for chronic prevention 4, 5
- Medication-overuse headache: Withdrawal of the overused analgesic or triptan is the primary recommendation; no specific preventive medication is supported by current evidence 5
- True sinus headache (from acute sinusitis): Treat the underlying infection rather than using migraine-specific agents 5
Critical Medication-Overuse Prevention
When rimegepant is appropriately used for confirmed migraine, it must be limited to ≤2 days per week (approximately 10 days per month) to prevent medication-overuse headache, which paradoxically increases headache frequency and can lead to daily headaches. 4, 6