Gepants for migraine

Gepants are a class of migraine medicines that target CGRP pathways. Some are used for acute treatment, some for prevention, and some have more than one approved use depending on the medicine and country.

They are not all interchangeable. The right question is which specific gepant is being prescribed, whether it is for acute treatment or prevention, and how often it should be used.

How are they different from triptans?

Gepants do not work the same way as triptans and may be options for people who do not respond to triptans or cannot use them. Mayo Clinic notes gepants do not seem to cause medication-overuse headache, but they are still prescription medicines with interaction and pregnancy/breastfeeding cautions.

What to track

For acute use, track attack start time, dose time, relief, recurrence, side effects, and whether you returned to function. For prevention, track migraine days, headache days, acute medication days, side effects, and missed activities over several weeks.

Ask before using

Ask your clinician what the medicine is for, how often to use it, what side effects to watch for, whether it interacts with your medicines, and whether it is safe for pregnancy plans or breastfeeding.

When to follow up

Follow up if attacks remain frequent, side effects occur, cost or access is a problem, or you are unsure whether the medicine is meant to replace or sit alongside another acute or preventive treatment.

Sources

• American Migraine Foundation: Gepants and ditans therapies
• American Migraine Foundation: Which targeted treatment should you try for migraine prevention?
• Mayo Clinic: Medication overuse headache