Acute and Preventive Treatment of Migraine

Migraine treatment is divided into three broad modalities: pharmacologic, neuromodulatory, and behavioral therapies

Lifestyle modifications for migraines include diet, trigger avoidance, hydration, exercise, sleep, stress management, and the use of diaries.

Ineffective, acute treatment of migraine can lead to:

Migraine-specific acute treatments are triptans, ergot derivatives,ditans and recently, gepants, which are CGRP small-molecule receptor blockers,

For acute treatment, three gepants have regulatory approval. They are ubrogepant, rimegepant, and zavegepant.

Rimegepant is an orally disintegrating tablet, and zavegepant, is the only approved nasalspray gepant.

Unlike triptans, gepants do not cause vasoconstriction. These drugs do not have the warnings or precautions for use in people with vascular disease or vascular risk factors that constitute class labeling for the triptans.

Gepants can be used in patientswho:

Rimegepant has the longest half-life of acute gepant drugs and is also approved as a preventive treatment. And that creates opportunities for novel treatment paradigms for both acute and preventive.

Rimegepant 75 milligrams every other day is approved for the prevention of episodic migraine