Migraine research continues to get more innovative and exciting over the last few years. Last year, for the first time in my 10+ years with migraine, I tried a medication that actually provided me with relief.
The new glass of drugs: gepants, began being approved and distributed early in 2020.
These are medications that work to target and block CGRP, a chemical within our body that shows a promising correlation to migraine attacks.
Prior to 2020, we had roll outs of the preventative CGRP medications Aimovig, Ajovy, and Emgality, with the newest one, Vyepti, hitting the market last year as well. The gepants however, are designed to be used to abort an attack. Although I personally didn’t have success with the preventative CGRP medicines, I find the gepants to be a different story.
Why The Change To Nurtec?
If you’ve read my post on Ubrelvy, you’ll know that I’ve had relative success with this medication. For a full in depth review you can read it here.
In short, Ubrelvy has been a game changer for me. I don’t experience any side effects and it works roughly half of the time providing relief typically within 2 hours, almost always within 8 hours, and it has a large potential to leave me in relatively low pain for upwards of two days after.
However, my overall migraine disease burden still has me incredibly disabled so the hunt for medications that work better is always on the back of my mind.
Nurtec, the second gepant to hit the market in 2020, provided me with a few reasons to consider this as perhaps a better treatment:
- Cost – My insurance covers both medications, but a three month supply of Nurtec is half the cost of a three month supply of Ubrelvy. Migraine is an especially burdensome disease on the wallet, so if a drug that acts in the same way as one that’s working well is available for less money, it’s like trying out the generic form of a medication to end up paying less. Currently no generic is available of either gepants.
- Absorption Method – Along with migraine, I also have IBS and research has shown that people with GI disorders often have complications and medications that have to be taken orally are less effective because we don’t absorb them as well or the absorption may not be consistent. Ubrelvy is an oral tablet whereas Nurtec dissolves on your tongue allowing for faster and more consistent absorption.
- Continuing Research of Nurtec as a Preventative Therapy – Currently, Rimegepant (Nurtec) is in the final stages of a drug trial testing the safety and effectiveness of using the gepant as an every other day preventative drug. We are expecting approval of this treatment soon and are hoping its an available option by the end of summer. This catches my attention for a few reasons. I didn’t tolerate the existing CGRP preventative drug Aimovig well at all and as a once a month shot, the half life of it – and the other CGRP shots – are too long and risky for me to keep trying. The gepants have much shorter half lives, Nurtec being only 11 hours. This means I could have a CGRP preventative drug with a smaller half life as a preventative and my success with Ubrelvy pointed towards me being a good candidate.
So, I asked my Neurologist for Nurtec to try as an abortive.
Getting Approved for Nurtec
I was not able to get samples of Nurtec to try before getting a full script, if this option is available to you I would recommend trying samples before or during the process of acquiring approval from your insurance.
Biohaven Pharmacies, the producer of Nurtec, offers a savings program where you can pay as little as $0 which you can find here on their website. However, my insurance is government based, so myself and anyone on Medicare/Medicaid are unable to utilize the cost savings programs.
My insurance – Tricare – covers Nurtec with a prior authorization. Without coverage, Nurtec costs about $900 for a single month supply, which is 8 pills.
Prior authorizations are needing to demonstrate to your insurance that the incredibly expensive drug you are requesting is actually something you need, that doesn’t have a generic (or that the generic does not work as well for you), and that it is better than your current treatment. Or that it is something you need in conjunction with another high cost medicine.
For this process, I worked with my doctor to submit the prior authorization on the basis that I had 1) tried and failed all other migraine abortive therapies, 2) that Ubrelvy wasn’t working good enough for me, and that 3) the different absorption method of Nurtec would be beneficial for me.
This process took roughly a month, my Neurologist just came out of retirement so although the prior authorization was approved we went back and forth learning how to prescribe accurate dosing. A few times prescriptions were submitted for 0 pills. For dosing information, my pharmacy is a mail order and prescribes in 3 month increments which would require 24 pills for 90 days – Nurtec comes in packs of 8 so for a single month your doctor may submit a prescription for 8 pills for 30 days. If you’re running into quantity problems, your pharmacist can likely help you get the information for proper prescribing.
How Has Nurtec Worked For Me?
In short, it hasn’t, and I’m really regretful that I wasn’t able to try samples before being stuck with multiple unopened packages.
On one occasion, I took the Nurtec much further into an attack, but my other trials taken as my pain increases have also yielded disappointing results.
The dissolvable tablet doesn’t taste bad, it’s a bit like a super fast dissolving breathmint, which is really nice. I don’t notice a drug aftertaste throughout the day after taking a Nurtec like I do with most other oral tablets, and I believe this must be because it dissolves.
Nurtec seems to knock my pain down by half a notch, but that’s it. I haven’t experienced any side effects.
It also doesn’t provide relief much later in the day – like Ubrelvy sometimes I notice positive results 8+ hours on rather than immediately – but I do not experience that with Nurtec.
Instead, I find myself struggling in pain and emotionally grappling with the fact that my treatment didn’t work, my migraine often continues to worsen, and I don’t have other treatment options. Nurtec is safe to take with other abortives if approved by your doctor, but my other abortive is Ubrelvy and the safety of taking these together is not known.
Nurtec also doesn’t allow a second dose of the medication within 24 hours.
I’ve had a lot of friends who have had great success with Nurtec, and I’m not really sure why it seems like I’m taking a sugar pill rather than a top of the line migraine treatment. Because I have had no success with any of my trials with Nurtec, I am discontinuing it and will return to using Ubrelvy.
Some people suggest trialing medications more than I have with this one, but for anyone reading this with severe chronic migraine you already know that when a treatment doesn’t even take the edge off a migraine, you’ve lost one of the few days you can treat each month and may have to rely on emergency intervention – if available to you – or lose multiple days as you ride out a painful attack.
This simply isn’t viable for me.
What My Experience Means Going Forward
Thankfully for me, Ubrelvy really has made a positive difference for me, so although I am disappointed that the less expensive option didn’t work, I am not at a total loss. And I would encourage anyone who has tried one of these meds to at the very least test out samples of the other. I’m not sure what causes our bodies to respond to some drugs and not others, and although these seem like practically identical options, anecdotally we know one might work better than the other and the only real way to know is to try it out yourself.
I have not totally given up on Nurtec as it relates to prevention either. I have a few questions surrounding usage and if I’d be able to use Ubrelvy as an abortive while adding Nurtec as a every other day preventative (once approved), but I definitely wouldn’t be opposed to trying it.
I personally think a difference between my success with these meds may have to do with dosing. I take the 100 mg dose of Ubrelvy, whereas Nurtec only comes in 75 mg. Perhaps as a preventative, the culminative effect would be greater and maybe dare I say successful?
I just don’t know.
And because I already have the medication, I have no problem holding on to it and finding out under the guidance of my headache specialist.
With the development of migraine drugs that can be used both as preventative and abortive medications, the shorter half lifes of the pill form CGRP vs the injections/infusions, and additional research I do have a lot of hope that additional gepants will be developed. Right now, my biggest migraine barrier is the frequency of my attacks and the infrequency with which I am allowed to treat them. Safer treatments like these that don’t contribute to medication overuse headache may provide people with frequent attacks the ability to treat them all, rather than selectively.
For more information regarding Nurtec, you can find other patient stories and information on their website here.
**disclosure: none of what is written here is intended to be a substitute for medical advice. If you are considering starting or stopping a medication you should consult with your doctor. This piece is solely anecdotal and is intended to serve as information for people seeking other patient experiences with Nurtec. This piece is in no way sponsored or affiliated with Biohaven Pharmacy.