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Clinician’s Corner: Treatment of an active migraine headache

More than 7 migraine headache treatment drugs have been approved in the past 18 months.  The newest categories are for treatment of an active migraine headache, unlike the drugs covered last week which are for prevention.

“GEPANTS” CGRP Antagonists for TREATMENT of ACUTE MIGRAINE HEADACHE

“Gepants” are small molecule drugs which block the CGRP receptor and are effective at both relieving migraines and preventing them. They quickly get into the brain and provide relief. Consider use after patients fail on two triptans or can’t take triptans due to heart problems. Two have been approved to date:

Ubrelvy (ubrogepant) 50mg and 100mg tablets: Approved Dec 23, 2019

Can be used to treat up to 8 migraines a month.

Drug interactions: some drug interactions that your Thompson Pharmacist can watch for. Must also have good kidney function.

Adverse effects: nausea, sleepiness, dry mouth, dizziness, or upper respiratory tract infections between 2-5% of patients.

Good news: no cardiovascular warnings, not controlled, not habit forming, savings card program.

Bad news: cost is over $90 per pill

Nurtec ODT (rimegepant sulfate): Approved Feb 27, 2020.

Drug interactions:  some drug interactions that your Thompson Pharmacist can watch for.

Adverse effects: Nausea and vomiting

Good news: no cardiovascular warnings, not controlled, not habit forming, savings card program.

Bad news: cost is over $90 per pill

Atogepant: A third gepant, atogepant, is currently being studied for use as a migraine preventive.

DITANS

Lasmiditan (Reyvow) is a newly approved (October 2019) migraine abortive tablet.

Available: 50- and 100-mg tablets, is a controlled (Schedule V) substance.

No constriction of the coronary or cerebral vessels and offers an alternative for those who cannot take the triptans. No better or no worse with respect to efficacy compared to triptans.

Warnings: do not drive for 8 hours after dosing, due to drowsiness even if not feeling impaired. Watch for serotonin syndrome.

In the 1990’s we had the triptans, which are all available generically and provide excellent headache relief for most of our patients at a reasonable cost.  Some patients with heart problems are unable to take triptans because they constrict blood vessels.  These new classes of drugs do not have any effect on blood vessels and safe for heart patients.  For patients that don’t get relief from triptans these can be another option to get relief.

These drugs are expensive, and your Thompson Pharmacist can help you bring down your copays with the manufacturer coupons.  Go Ahead and ASK…at Thompson Pharmacy it’s ALL for YOU!!