When you live with migraine, you know how devastating it can be to your quality of life. To treat it and protect your overall well-being, it’s important to find the medication that works best for you. You probably know how frustrating and tricky that process can be.

In your efforts to find help, you may have already tried non-opioid pain medicines. Doctors often prescribe them before trying other options. They may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • Acetaminophen
  • A medicine that contains caffeine, NSAIDs, and acetaminophen  

But if these don’t give you the relief you need, your doctor might prescribe a newer treatment called calcitonin gene-related peptide (CGRP) inhibitors. 

CGRP is a protein in your brain and nervous system that causes inflammation in certain parts of your brain. This can lead to migraine, a headache disorder that gives you severe head and neck pain and other symptoms. Migraine attacks can make it hard to go about your daily activities or work. 

Your doctor may prescribe CGRP inhibitors for your migraine. These meds are unique because they can treat migraine attacks and also prevent them from occurring. CGRP inhibitors used to treat migraine come as a tablet that dissolves in your mouth, a pill you swallow, or a nasal spray. 

Depending on whether you have other symptoms with your migraine attacks and how severe they are, your doctor may prescribe additional meds to help manage your symptoms. If you have nausea or vomiting during your migraine attacks, your doctor may prescribe an antiemetic, a medicine that lowers your chances of nausea and vomiting.

How Do CGRP Inhibitors Work?

When you're having a migraine attack, your body releases CGRP at higher levels than usual, research shows. This plays a role in sending pain messages to your body. That’s because migraine attacks happen through a series of steps that involve different proteins. CGRP inhibitors bind to the CGRP receptor on nerve endings that generate migraine pain and block CGRP from binding. This, in turn, stops your migraine symptoms.

The CGRP inhibitors listed above are FDA-approved for acute treatment of migraine in adults with or without aura. An acute treatment for migraine is when you take medicine as soon as your symptoms begin. 

Migraines are classified into three levels: mild, moderate, and severe. 

CGRP inhibitors are usually considered second-line therapies for moderate to severe migraine attacks. Second-line therapies are medicines often prescribed when the first treatment (first-line therapy) doesn’t work or stops working. Your doctor may also try non-opioid pain medicines to help with your migraine symptoms before they start you on CGRP inhibitors. 

CGRP inhibitors may not be a good fit for everyone. Tell your doctor if you’ve had any allergies to medicines. Also, tell them about all the medicines you’re taking.

Which CGRP Inhibitors Are Used to Treat Acute Migraine?

How Do You Take CGRP Inhibitors?

CGRP inhibitors come in different forms. You take them as needed for your migraine symptoms. Here’s how you take the three CGRP inhibitors used to treat migraine:

Nurtec. This is an orally disintegrating tablet (ODT), which means it’s placed under your tongue and dissolves without water or other liquids. Nurtec comes as a 75-milligram ODT. Don’t take more than one ODT in a 24-hour period. 

Ubrelvy. This comes in 50-milligram and 100-milligram tablets that you take with or without food. It can be taken again 2 hours after the first dose if your migraine symptoms haven’t improved. It’s not recommended to take more than 200 milligrams of Ubrelvy in a 24-hour period. 

Zavzpret. This comes as a nasal spray at 10 milligrams per spray. It’s sprayed once in one nostril. Don’t use more than one spray in a 24-hour period. 

Before using Zavzpret, it’s important to blow your nose to clear anything that might block the medicine from being absorbed properly. While spraying the medicine in one nostril, make sure to close your other nostril with your finger. Immediately after spraying it, breathe in through your nose and out through your mouth for 10 to 20 seconds. 

Don’t tilt your head when spraying Zavzpret into your nostril. Make sure you throw the medicine away after using it. Each nasal spray contains one dose of the medicine. If you’re prescribed Zavzpret, it’ll usually come with a leaflet of step-by-step instructions.

When taking any medicine, be sure to follow instructions from your doctor. Tell them if you feel like your medicine isn’t working or if your symptoms get worse. 

CGRP Inhibitors Dosing Schedule infographic

Are CGRP Inhibitors Safe? 

CGRP inhibitors are generally safe and well-tolerated, with no more than 30% of people experiencing side effects in clinical studies. Like all medicines, there are risks and side effects you should be aware of if you take a CGRP inhibitor. 

The most common side effects with CGRP inhibitors are:

  • Changes in your taste (commonly seen with Zavzpret)
  • Discomfort in your nose (commonly seen with Zavzpret)
  • Nausea
  • Vomiting
  • Drowsiness or sleepiness

Managing Side Effects of CGRP Inhibitors infographic

If your side effects get worse, don’t go away, or bother you, call your doctor. Because CGRP inhibitors can cause drowsiness, it’s important not to drive or operate heavy machinery until you know how the medicine affects you. 

Nasal sprays can cause a change in your ability to taste food. They may also cause discomfort in your nose. If you have either of these side effects, talk to your doctor about CGRP inhibitors that you can take by mouth. 

Always talk to your doctor about the risks and benefits of these medicines. If your migraine symptoms aren’t getting better or they’re worse, talk to your doctor. They might add additional medicine, give you a different CGRP inhibitor, or switch you to a completely different medicine. Tell them about all the medicines you take and all the health conditions you have so they can make sure any meds are being used safely. 

Will Insurance Cover the Cost?

Depending on your insurance company and the CGRP inhibitor you take, your doctor may need to send your insurance provider a prior authorization before you can receive your medicine. A prior authorization is a process put in place by your insurance company to determine if they’ll pay for certain medicines. 

The process can vary and may depend on different factors, like whether you’ve tried other medicines and how severe your symptoms are. 

Your doctor will usually notify your insurance company, or the pharmacy may notify your doctor if your insurance company needs a prior authorization. Once that’s provided, your insurance company decides if they’ll cover the cost of your medicine.

5 Things to Consider When Choosing a Treatment

When working with your doctor to choose a treatment for your migraines, several things should be considered. They include: 

bandage icon

Severity of your migraine. Whether your migraine is mild, moderate, or severe will help your doctor know the best treatment for you. 

illustration of syringe and bottle

Delivery methods. CGRP inhibitors for treating migraine include tablets that dissolve in your mouth, pills you swallow, and a nasal spray.

chart and pills icon

 Prior treatments. Your insurance company may require you to try other medicines for migraines before they’ll cover CGRP inhibitors. 

dollar sign icon

Cost. CGRP inhibitors can cost around $1,000-$4,000 per prescription. This cost varies, depending on whether your insurance is a commercial plan, private plan, Medicare, or Medicaid. It can also depend on whether you’re enrolled in a savings program provided by the drug manufacturer. 

arrows icon

Coexisting conditions. Certain CGRP inhibitors are generally not recommended if you have severe liver or kidney problems. Make sure to tell your doctor about any current and past health conditions and any other medicines you’re taking. If you take a CGRP inhibitor with certain other meds, it may affect your blood levels. Your doctor can decide if this is the case. It isn’t known how safe CGRP inhibitors are when you’re pregnant or breastfeeding. 

Talk with your doctor about these five things to consider when choosing the best treatment for your migraine and boosting your well-being and quality of life.  

Show Sources

SOURCES:

American Medical Association: “What doctors wish patients knew about prior authorization.”

American Migraine Foundation: “What to Know About the New Anti CGRP Migraine Treatment Options.”

Headache: “Zavegepant nasal spray for the acute treatment of migraine: A Phase 2/3 double-blind, randomized, placebo-controlled, dose-ranging trial.”

Headache: The Journal of Head and Face Pain: “The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice.”

Innovations in Clinical Neuroscience: “CGRP Inhibitors for Migraine.”

JAMA: “Effect of Ubrogepant vs Placebo on Pain and the Most Bothersome Associated Symptom in the Acute Treatment of Migraine The ACHIEVE II Randomized Clinical Trial.”

MedlinePlus: “When you have nausea and vomiting.”

National Institutes of Health: “Migraine with Aura.”

National Institute of Neurological Disorders and Stroke: “Migraine.”

Nurtec (Pfizer) US Prescribing Information, April 2023;  US Prescribing Information, April 2023.

National Institute of Neurological Disorders and Stroke: “Migraine.”

Nurtec ODT: “How to Take Nurtec ODT.”

Pfizer: “Information for Colorado Prescribers of Prescription Drugs.”

Lancet: “Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: A randomized, phase 3, double-blind, placebo-controlled trial,” “Safety, tolerability, and efficacy of zavegepant 10 mg nasal spray for the acute treatment of migraine in the USA: A phase 3, double-blind, randomized, placebo-controlled multicentre trial.”

New England Journal of Medicine: “Ubrogepant for the Treatment of Migraine.”

Ubrelvy (Abbvie) Patient Information, June 2023; Prescribing Information, June 2023.

Ubrelvy (ubrogepant): “Cost and Savings.”

Zavzpret (Pfizer) Patient Information, March 2023; Prescribing Information, March 2023.