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What are the new drugs for the treatment of migraines?

Medically reviewed by Judith Stewart, BPharm. Last updated on Oct 6, 2021.

Official Answer

by Drugs.com
  • The newest drug (approved February 27, 2020) for the treatment of migraine is Nurtec ODT (rimegepant).
  • The newest formulation of an older drug (approved September 2, 2021) for the treatment of migraine is Trudhesa (dihydroergotamine mesylate).
  • The newest drug (approved September 28, 2021) for the prevention of migraine (episodic migraine) is Qulipta (atogepant).

New Drugs for the Treatment of Migraine

  • The newest drugs for the acute treatment of migraine are Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant), both orally-administered calcitonin gene-related peptide (CGRP) receptor antagonists (gepants).
  • Another new drug for the acute treatment of migraine is Reyvow (lasmiditan), the first serotonin (5-HT)1F receptor agonist.
  • The other new drugs for the acute treatment of migraine are novel formulations of older drugs such as sumatriptan, belonging to the class of drugs called serotonin (5-HT) receptor agonists (triptans) and dihydroergotamine, an ergotamine derivative.
    • Sumatriptan is a well-established migraine treatment first approved in subcutaneous injection form under the brand name Imitrex in 1992. Sumatriptan is available in a variety of dosage forms, including injection, oral tablets, nasal spray, and nasal powder. Some formulations are also available as generics.
    • Dihydroergotamine was first approved in injection form under the brand name D.H.E. 45 in 1946 and as a nasal spray under the brand name Migranal in 1997. Some dihydroergotamine formulations are also available as generics.

The following drugs are FDA approved for the acute treatment of migraine with or without aura in adults.

Drug Name FDA Approval Company Drug Class Dosage Form Administration
Trudhesa
(dihydroergotamine mesylate)
September 2, 2021 Impel NeuroPharma, Inc. ergotamine derivative nasal spray

as needed; a dose (0.725 mg into each nostril) may be repeated a minimum of 1 hour after the first
dose (do not use more than 2 doses within a 24-hour period or 3 doses
within 7 days)

Nurtec ODT (rimegepant) February 27, 2020 Biohaven calcitonin gene-related peptide (CGRP) receptor antagonist (gepant) orally disintegrating tablets

as needed; no more than one dose (75 mg) to be taken in 24 hours
(the safety of taking more than 18 doses in a 30-day period has not been established)

Ubrelvy
(ubrogepant)
December 23, 2019 Allergan plc calcitonin gene-related peptide (CGRP) receptor antagonist (gepant) oral tablets

as needed (a second dose may be administered at least 2 hours after the initial dose); no more than 200 mg to be taken in 24 hours

Reyvow (lasmiditan) October 11, 2019 Eli Lilly and Company serotonin (5-HT)1F receptor agonist (ditan) oral tablets

as needed; no more than one dose to be taken in 24 hours

Tosymra (sumatriptan) January 25, 2019 Dr. Reddy’s Laboratories Limited serotonin (5-HT)1B/1D receptor agonist (triptan) nasal spray

as needed; no more than 30 mg to be taken in 24 hours (doses separated by at least one hour)

Zembrace SymTouch (sumatriptan) January 28, 2016 Dr. Reddy’s Laboratories Ltd. serotonin (5-HT)1B/1D receptor agonist (triptan) subcutaneous injection

as needed; no more than 12 mg to be taken in 24 hours (doses separated by at least one hour)

Onzetra Xsail (sumatriptan) January 27, 2016 Avanir Pharmaceuticals, Inc. serotonin (5-HT)1B/1D receptor agonist (triptan) nasal powder

as needed; no more than two doses (44 mg) to be taken in 24 hours (doses separated by at least two hours)

New Drugs for the Prevention of Migraine

The newest drugs for the prevention of migraine belong to the class of drugs called calcitonin gene-related peptide (CGRP) antagonists and include Aimovig, Ajovy, Emgality, Vyepti, Nurtec ODT, and Qulipta.

Monoclonal Antibody CGRP Antagonists
The long-acting, large molecule, monoclonal antibody CGRP antagonists work by blocking the activity of the calcitonin gene-related peptide, a neuropeptide that has been implicated in the pain and vasodilation processes associated with migraine attacks.

  • Aimovig is a fully humanized monoclonal antibody that works by binding to the calcitonin gene-related peptide receptor.
  • Ajovy, Emgality, and Vyepti are humanized monoclonal antibodies that target the calcitonin gene-related peptide ligand.
  • Aimovig, Ajovy, and Emgality are all intended for self-injection using a single-dose prefilled syringe or autoinjector. Vyepti is administered via intravenous infusion.

Gepant CGRP Antagonists
The gepants are small molecule CGRP antagonists that can be administered orally. They work by blocking the CGRP receptor.

  • Nurtec ODT is a dual therapy used for both acute and preventive treatment of migraine. It is taken as needed for the acute treatment of migraine, and every other day for the preventive treatment of episodic migraine.
  • Qulipta is taken once daily for the preventive treatment of episodic migraine.

The following drugs are FDA approved for the preventive treatment of migraine in adults.

Emgality is also approved for the treatment of episodic cluster headache in adults.

Drug Name FDA Approval Company Drug Class Dosage Form Administration
Qulipta
(atogepant)
September 28, 2021 AbbVie Inc. calcitonin gene-related peptide (CGRP) receptor antagonist (gepant) tablets

once daily

Nurtec ODT (rimegepant) also approved for treatment Biohaven calcitonin gene-related peptide (CGRP) receptor antagonist (gepant) orally disintegrating tablets

every other day

Vyepti (eptinezumab-jjmr) February 21, 2020 Lundbeck Inc. calcitonin-gene related peptide antagonist intravenous infusion

once every three months

Emgality (galcanezumab-gnlm) September 27, 2018 Eli Lilly and Company calcitonin-gene related peptide antagonist subcutaneous injection

once monthly

Ajovy (fremanezumab-vfrm) September 14, 2018 Teva Pharmaceutical Industries Ltd. calcitonin gene-related peptide antagonist subcutaneous injection once monthly OR once every three months
Aimovig (erenumab-aooe) May 17, 2018 Amgen Inc. calcitonin gene-related peptide antagonist subcutaneous injection once monthly

New Drugs in Clinical Development

Zavegepant (formerly BHV-3500 or vazegepant) is a third generation, high affinity, selective and structurally unique, small molecule CGRP receptor antagonist potentially suitable for multiple routes of delivery, including nasal, subcutaneous, inhalation or oral administration. It is currently in clinical development for the acute and preventive treatment of migraine.

For more information, see Treatment & Prevention Tips for Living with Migraine Headaches

For a complete list of migraine treatments, see Medications for Migraine

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