B.B. is a 32-year-old woman who has suffered from monthly migraines since she was about 15. The first two days of her period were so bad that as a teenager she couldn’t go to school; as an adult, she also can’t work for those two days each month.
She tried multiple medications, but experienced too many side effects. Continuous birth control pills also failed to eliminate her periods.
She was struggling until last year, when we started her on a new medication, Nurtec ODT (rimegepant) by Biohaven Pharmaceuticals. For B.B., it did the trick.
To understand how it works, we need to try to understand what causes a migraine, though this is still up for debate. Migraines are a neurovascular disorder, probably caused by a calcitonin gene-related peptide (CGRP). As this peptide is released into the brain blood supply, it causes an inflammatory response that elicits severe pain (a migraine). Rimegepant is a small molecule CGRP receptor antagonist that blocks the peptide from eliciting this inflammatory response and hence eliminates the pain. It doesn’t cause vasoconstriction, which can be important with patients with heart disease….