I’ve tried Ubrelvy (ubrogepant) and Nurtec ODT (rimegepant)
My migraines respond very well to sumatriptan, but I do like to try new treatments that I recommend to my patients.
A few months ago two new abortive drugs to treat acute migraine attacks were approved by the FDA. Ubrelvy (ubrogepant) and Nurtec ODT (rimegepant) block CGRP, a substance released during a migraine attack. They work in a similar way to four injectable drugs used for the prevention of migraines – erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti). I’ve tried erenumab and fremanezumab with some relief, but stopped both because sumatriptan works well and I don’t really need any preventive medications.
Because the two injectable drugs did help, I expected the two new oral medications to work as well. Alas, neither one had any effect. This suggests that CGRP is not very operational in my case. The fact that sumatriptan, a drug that works on serotonin receptors works so well indicates that the serotonin system is dominant in producing my migraines.
Migraine is a very heterogeneous disorder with a variety of clinical presentations and with dozens of identified genetic abnormalities that predispose one to migraines. This means that we are not likely to have a drug that works for all migraine patients. What we do expect, is the advent of personalized medicine – having tests that predict which drug will work for which patient.
Antidepressants do work on the serotonin system. I also occasionally use triptans (sumatriptan and others) for prevention.
Are there any preventative drugs that target the serotonin system?
Instead of an autoinjector you may want to ask your doctor to prescribe a prefilled syringe instead. However, it’s possible that the reaction was to Ajovy rather than latex, so I would try Emgality instead.
Do all migraine injections contain latex fillers? If not, which ones don’t. I had a sever allergic reaction to Ajovy injections and my neurologist said it’s because it contains a latex filler.
Yes, they certainly can. I’ve seen it in a handful of my patients and so have my colleagues.
Do you know if Ajovy or similar injectables can cause transient alopecia? I am exploring Ajovy as an option and my migraine doctor mentioned that it can happen. I cannot readily find it as a side effect, and was wondering how common it is.
Even if one CGRP oral or injectable drug did not help, it does not mean that a different one will not help either. It is worth trying a few before giving up.
If I tried NURTEC as a preventative and it didn’t help at all, does that mean that another CGRP like Ajovy would most likely not help?
Dr. Mauskop, I can’t thank you enough for answering my concerns. I have ordered the paper version of the book today. You are doing a great service by giving such valuable information. To get answers from my neurologist, I would have to wait for days to get an appointment.
I disagree – see my book. It’s only $3.95.
Thanks for replying Dr. Mauskop. I got concerned after many neurologists (including Stanford) warned me about MOH and after reading https://pubmed.ncbi.nlm.nih.gov/12370454/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780979/
I would like to know your opinion on this. Thank you once again!
Even if Ubrelvy does not help, injectable CGRP preventive drugs can be effective. Maxalt, on the other hand, is not likely to cause rebound. You may want to read about it in my new book – The End of Migraines: 150 Ways to Stop Your Pain.
My migraines respond well to Maxalt. Last few months, I’m getting terrible hormonal migraines that last for 10-12 days starting from day 1 of my menstrual cycle. These migraines are also more severe and have a tendency to relapse. I don’t get headaches on other days since I started taking Magnesium, CoQ10 and B2. I find myself taking Maxalt, ibuprofen or tylenol for 10-12 days continuously. I am worried that I’ll develop rebound headaches. Botox and other preventives didn’t help. I tried Ubrelvy but that didn’t work at all. Is it possible that the CGRP injectibles might not work for me since they work similarly to Ubrelvy? I am 44.
Trokendi is very well known to cause hair loss, so most likely that was the cause.
Do you know if Ubrelvy and/or Nurtec cause hair loss/thinning? I’ve taken each of these medications to great effect about 5-6 times per month for the past seven months but my hair is *very* thin now. I stopped Trokendi around the same time that I started the CGRP medication so perhaps the thinning was due to Trokendi?
I was also recently prescribed Nurtec as my migraines tend to recur after the rizatripan wears off and Nurtec is supposed to be longer lasting. My experience was similar to yours in that I noticed no effect at all from the Nurtec. Pretty disappointing, but onwards to the next one I suppose…
So far, these tests exist only for psychiatric and epilepsy drugs.
You write “What we do expect, is the advent of personalized medicine – having tests that predict which drug will work for which patient.” can you perhaps quote any peer-reviewed papers that start to look at such tests? Thank you!
Most likely, they are not totally separate systems but rather they overlap with one being more dominant. Many patients respond to both CGRP drugs and triptans.
Now you wrote something really interesting. “The fact that sumatriptan, a drug that works on serotonin receptors works so well indicates that the serotonin system is dominant in producing my migraines.”
You actually believe we can have different systems that produces our migraines? Serotonin, CGRP… are there more systems you know of, or suspect they exist?