Combination Therapy: Nurtec and Ubrelvy
I recently shared some details about my experience working with a headache clinic. I shared their personalized treatment plan approach for me, combining three preventive medications and a small selection of abortive medications to reduce the frequency and severity of my migraines and my need to seek out emergency treatment.
A combination of CGRPs
One portion of the plan which remains very interesting to me is the combination therapy of Nurtec and Ubrelvy, both CGRPs.
A CGRP, or calcitonin-gene-related peptide, is a protein that is found in high levels in people during a migraine attack. A CGRP medication acts as a receptor, blocking the proteins ability to work, which reduces migraine symptoms.
The first medication in this class that I am taking is Nurtec, a dissolvable pill that is now approved for both treating migraine attacks AND preventing migraines (as of May, 2021). My doctor prescribed this medication to be taken every other day, regardless of my migraine status. By using it as a preventative alongside nebivolol and EBH4, the hope is that Nurtec would reduce the propensity of my migraines.
In addition, in my small arsenal of abortive medications I was prescribed Ubrelvy, another CGRP medication, this one a swallowable pill that comes in two different doses, and can be used for the acute treatment of migraines. It is fast acting, and is recommended for immediate treatment of a migraine.
My doctor's instructions
My doctor gave me specific instructions. The Nurtec, 75mg, was to be taken every other day without fail. On days that I took Nurtec, and needed an abortive migraine medication, I was to use another category of medication - an NSAID like ketoralac or Fioricet, a combination of acetaminophen, caffeine, and butalbital. Now, on the opposite days that I did not take Nurtec, Ubrelvy was to be used as my first line of defense against a raging migraine. He prescribed the stronger pills (100mg) and my instructions involve taking one with the option to take a second two hours later if I haven't gotten enough relief.
Remembering my migraine medications
As someone who manages other health conditions in addition to migraines, works full time, and has a young child, remembering which mornings I had and had not taken Nurtec became a challenge for me. I found the simplest solution I could - I added a recurring note on my calendar every other day, aligning with the days that I did in fact take Nurtec and thus needed to avoid Ubrelvy.
The benefits of taking both medications
Although there are a few additional components to my migraine prevention and treatment plan, the combination therapy utilizing Nurtec and Ubrelvy is really the main star of the show. If I had any doubt about how these medications were working together, I saw firsthand their professional teamwork during the week after my last IVF cycle. In a time notorious for the plummeting of estrogen levels and the onset of a raging menstrual migraine, my doctor asked me to take Ubrelvy, preemptively, on the days opposite the days I took Nurtec for one week.
During this time, I'm so happy to say that I did not need to utilize any "additional" abortive medications, and remained fully functioning - something that never could've happened before this plan was put into place.
I'm so interested to hear if anyone else is utilizing this same combination therapy as part of their treatment plan, and how its working!
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