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Key takeaways
Nurtec ODT (rimegepant) is a medication approved in 2020 for abortive treatment of migraine and in 2021 for preventive treatment, working by blocking CGRP receptors to reduce inflammation and pain.
For acute use, it should be taken at the onset of migraine symptoms for best results, with many users experiencing pain relief and improved function within 60 minutes, and significant improvement within two hours.
For preventive use, Nurtec has shown a 30% reduction in migraine frequency within the first week of use and has a long half-life, necessitating dosing every other day.
Common side effects are mild, including nausea and stomach pain, but Nurtec is not recommended for individuals with severe kidney or liver impairment, and it’s important to discuss potential drug interactions with a doctor.
Before the first migraine-specific drugs hit the pharmaceutical market in 2018, the medications used to treat migraine were meant for other health conditions. Antidepressants, beta blockers, and epilepsy drugs reduced in many people, but no one knew for sure how or why. Many people who live with migraines were left without help when those drugs didn’t work for them.
There is a new generation of migraine medications, which block something called calcitonin gene-related peptide, or CGRP. “During a migraine attack, CGRP is released, [then] attaches to and activates receptors in the brain, which propagate pain signals,” says Lauren R. Natbony, MD, medical director of Integrative Headache Medicine of New York.
One of these CGRP-targeting medications, Nurtec ODT (rimegepant), was approved in 2020 as an abortive treatment for migraine. Abortive means you can take it after a migraine begins to stop symptoms, as a rescue medication to relieve your symptoms. Then, in 2021, approval was expanded to include use of Nurtec as a preventive migraine treatment—taken once every other day. When it is taken every other day, it’s been shown to reduce the number of monthly migraine days while causing few side effects.
So how, exactly, does Nurtec work to both treat and prevent migraines…and what should you expect it to do for you? Here’s what you need to know.
How does Nurtec work?
Older migraine medications, like propranolol, sumatriptan, and nortriptyline, are believed to reduce migraine episodes by working along the central nervous system; they increase low serotonin levels (sometimes considered a risk factor for migraine), prevent vasodilation, and block certain other receptors that can contribute to migraine. But as an anti-CGRP medication, Nurtec doesn’t do any of these things.
“Nurtec works by blocking CGRP receptors like a plug,” says Dr. Natbony. “When CGRP is released, it cannot bind to and activate the receptor; this prevents CGRP from triggering the cascade of inflammation that results in severe migraine pain.”
That’s how Nurtec relieves symptoms of an existing migraine, but what about prevention? The mechanism of action is still similar, says Dr. Natbony, with Nurtec providing a more continuous blockade of CGRP receptors which makes it more difficult for a migraine attack to be triggered.
How to take Nurtec
If you’re taking Nurtec to treat a migraine on the spot, it works pretty quickly compared to other abortive treatments. Unfortunately, no migraine medications work immediately (yet!). But you should take Nurtec as soon as you notice a migraine starting for best results, says Joanna Lewis, Pharm.D., of The Pharmacist’s Guide.
When should you take Nurtec?
“The best time to take it…is as soon as you feel a migraine attack coming on,” Dr. Lewis recommends. “Sometimes people wait until the pain becomes unbearable, but it’s actually best to take the medication as soon as [it starts].”
How long does Nurtec take to work?
As far as how you’ll feel after taking a dose, Dr. Natbony says many people will experience some amount of pain relief and what she calls “freedom from functional disability” around 60 minutes post-dose. In other words, after one hour most people are able to gradually begin resuming their daily activities. You might not be completely symptom-free at that point, but you’ll typically keep improving from there, with most people feeling significantly better about two hours after taking Nurtec.
If you’re taking Nurtec regularly to prevent migraine, you can expect fairly quick results, too, says Dr. Natbony: “In clinical trials, there was a 30% drop in migraines within the first week [when Nurtec was taken preventively].”
Nurtec side effects
The other bit of good news is regarding side effects, which Dr. Lewis says are usually relatively mild; nausea and stomach pain are the most commonly reported side effects, but have only been found to occur in fewer than 3% of people taking Nurtec. Nurtec is not safe for you if you have severe kidney or liver impairment.
How long does Nurtec last?
Nurtec has a long half-life, says Dr. Natbony, which allows it to prevent and treat symptoms for about 48 hours at a time.
How often do you take Nurtec?
If you take it as an abortive medication, it can relieve your symptoms and keep them away for a while. If you’re using it preventively, you’ll still only need to take it every two days because of how long it stays active in your system.
“For preventive use, take Nurtec at the same time every other day,” advises Dr. Lewis. “Taking it in the morning or evening does not matter, [but if you get nauseated] from the medication, take it in the evening.”
How do you know if you need Nurtec?
Nurtec is generally recommended for people with episodic migraine, or people who have no more than 14 migraine days per month. It’s a good option for people who haven’t had success with other types of migraine medications, who have struggled with the side effects of other migraine medications, or who want to combine their preventive and abortive medications into one convenient drug.
According to Dr. Lewis, Nurtec may also work well for people who can’t take triptans because of the side effects or co-existing cardiovascular disease, as well as for people who regularly have nausea and/or vomiting with their migraine attacks.
“Because Nurtec dissolves under the tongue, it does not go through the stomach to be absorbed,” says Dr. Lewis, “which can result in quicker relief and better pain relief for those who are having a hard time keeping medication down due to nausea.”
Ultimately, though, you should always talk to your doctor about whether Nurtec is right for you. While it works for many people, it’s not right for everyone—and Dr. Lewis notes that it has several drug interactions, so make sure you let your prescribing doctor know about all the other medications and supplements you take.