Trying Oral Preventives That Target CGRP

After my migraine attacks got temporarily worse on an injectable CGRP medication a few years ago, I’ve been hesitant to try another one. My headache specialist urged me to because Ubrelvy was an effective abortive for me, which he said indicated I might do well on a related preventive. Still, I hesitated to try another injection after my experience with the first one. I’m so glad my doctor urged me to consider oral preventives that target CGRP.

What are the non-injectable CGRPs?

There are currently two medications for migraine prevention that target CGRP and aren’t injections: Qulipta (atogepant) and Nurtec (rimegepant). Qulipta is a reformulated version of the abortive Ubrelvy (ubrogepant), which is designed to be taken daily. The preventive version of Nurtec is exactly the same medication that’s used as an abortive, but it’s taken every other day.

Why might someone avoid injectables?

Dislike of needles is usually assumed to be the reason someone wants to avoid an injection. While that’s certainly a legitimate reason, some people are allergic to ingredients in the injection liquid but not to ingredients in the oral medications. Others, like me, may not want to wait more than a month for the injectable medication to clear their system if they have side effects. Still, others need an alternative after the injections stop being effective.

Why do injectables lose their efficacy?

Some people do great on the injections for a few months, then their improvement disappears. While researchers don’t yet know why this happens, my headache specialist told me one of the possible reasons is that the injections are monoclonal antibodies and some people’s bodies develop antibodies in response, which counteract the medication. The oral medications that target CGRP don’t have monoclonal antibodies, so if this is the issue, there’s no risk of the same outcome.

Why is it hard to get Qulipta?

My headache specialist told me that it can be hard for people with chronic migraine to get Qulipta because it has FDA approval for episodic migraine, not chronic (although Allergan, the manufacturer, has since applied for FDA approval for chronic migraine). He also said that “fail first” is common with both medications. However, he also said his office has had a high success rate appealing insurance denials, especially if a person has already tried the injections and they couldn’t continue on them for some reason.

Why didn't I want to take Nurtec?

I really wanted to take Qulipta - I already knew that Ubrelvy is an effective abortive for me, it’s easier to remember to take a medication daily, and I dislike the flavor of the Nurtec orally disintegrating tablets. Unfortunately, Nurtec was the only option with my insurance.

Is Nurtec working for me?

I’ve been taking Nurtec preventively for a month and am quite pleased. It’s the only preventive that has managed my weather-triggered migraine attacks so well. I’m completely unaffected by monsoon season in Phoenix when it has always been a migraine trigger in the past. I’ve found tricks to remember to take the medication on time and have gotten used to the taste, so my initial reservations haven’t been a concern.

What is the silver lining?

A benefit I didn’t expect is because preventive Nurtec is the same dose as abortive Nurtec, I can expose myself to things that would normally be triggers and then knock out the migraine attack when I take my preventive. Not having a migraine attack every time it’s cloudy is giving me a huge amount of freedom. Having the flexibility to enjoy things that would normally be a trigger is the cherry on top.

Have you tried oral CGRP preventives?

I haven’t heard from many other people who take oral preventives that target CGRP. I’d love to know how the experience has been for others.

Have you tried Quilipta or preventive Nurtec? If so, please share your experience in the comments.