Rimegepant for Migraine Prophylaxis

Introduction to Rimegepant

The American College of Physicians, as reported in the Annals of Internal Medicine, recommends rimegepant 75 mg to be taken orally every other day for the preventive treatment of episodic migraine in adults, with efficacy assessed after 3-6 months of treatment 1, 2

The American Academy of Neurology suggests continuing rimegepant treatment for at least 3-6 months before assessing efficacy—do not abandon treatment prematurely 1, 2

The American Headache Society suggests considering rimegepant for patients adversely affected by migraine on ≥2 days per month despite optimized acute treatment 2
The VA/DoD guideline gives rimegepant a "neither for nor against" recommendation for episodic migraine prevention, noting that the 0.8-day reduction in monthly migraine days was statistically but not clinically significant by their threshold 1

The American College of Physicians, as reported in the Annals of Internal Medicine, states that the primary outcome of rimegepant treatment is a reduction of approximately 0.8 monthly migraine days compared to placebo during weeks 9-12 of treatment 1

The American Academy of Neurology notes that unlike erenumab, rimegepant has not been associated with development or worsening of hypertension in post-marketing surveillance 3

The European Academy of Neurology suggests considering pausing preventive treatment after 6-12 months of successful therapy to assess whether continued prevention is necessary 4, 2

The American College of Physicians, as reported in Praxis Medical Insights, notes that rimegepant is substantially more expensive than traditional preventive medications, with annual costs ranging from $7,071 to $22,790 3

The American Headache Society advises against assessing efficacy before 3-6 months of treatment—premature discontinuation is a common error 1, 2
The American College of Obstetricians and Gynecologists recommends not prescribing rimegepant during pregnancy due to limited safety data 2
The American Academy of Neurology suggests not expecting dramatic reductions in migraine frequency—the clinical benefit is modest (approximately 1 fewer migraine day per month versus placebo) 1