Thread by @beth_morton

This week’s #MigraineChatAMA covered acute CGRPs (gepants). There weren’t a lot of questions, so I threw in a few extra resources. There are Qs for the #MigraineChat community at the end.

Nothing here is medical advice. Talk to your doc before making changes. #MigraineChatAMA /1

Do acute gepants work for those w/chronic migraine (CM)?

Clinical trials typically look at ppl w/episodic migraine first: either excluding ppl w/CM or not enrolling enough to obtain reliable results for the CM subgroup. #MigraineChatAMA
/2

I couldn’t find studies of gepants for acute use in CM. Anecdotally, though, yes! The #MigraineChat community has shared experiences w/Ubrelvy & Nurtec as acute treatments even for those with chronic migraine. #MigraineChatAMA /3

Search “gepant” or med names (brand or generic) + #MigraineChat to see prior Qs.

FWIW I have CM. The acute gepants help & might hold off my next big attack longer than my other acute meds. Not 100%, but I have more success w/gepants if I catch attacks early. #MigraineChatAMA /4

.@HemingwayMuse wrote about her Nurtec experience. While it wasn’t successful for her, it is a good discussion of the pros, cons, and getting access. #MigraineChatAMA /5

Worth mentioning, many of us with CM have tried other acute treatments. At least Ubrelvy appears to be effective in those who’ve had other treatments fail them.
neurologylive.com/view/ubrogepan…
#MigraineChatAMA /6

Other info on gepant side effects & contraindications:
SEs (in trials): Ubrelvy - nausea, drowsiness, dry mouth, upper respiratory infection, often more frequent at 100 mg ubrogepant group, but all < 5%. Nurtec - urinary tract infection, nausea (both < 2%) #MigraineChatAMA /7

Source for the prior tweet.
link.springer.com/article/10.100…

Like the preventive CGRPs, real-world use of the gepants seems to have revealed a few additional side effects through anecdotes. Questions come up regularly in #MigraineChat spaces. Always feel free to ask. #MigraineChatAMA /8

Contraindications. Ubrevy seems safe in those w/cardiovascular conditions. However, it shouldn’t be used in people with end-stage renal disease and dose adjustments made for those with severe liver disease/failure. #MigraineChatAMA /9

Other notes:
(+) Nurtec *might* be safe during lactation as <1% of the parent dose is passed to the infant (talk w/your doc!).
(-) Taking gepants w/high fat meal can delay effectiveness. Grapefruit (or taking other CY3A4 inhibitors) should be avoided. #MigraineChatAMA /10

Real-world evidence supports the safety and effectiveness of using an acute gepant with a preventive monoclonal antibody. Most of the studies on saftey of a mAb + gepant are small, though. See last week’s thread for details. #MigraineChatAMA /11

On effectiveness: “The analysis of the ubrogepant plus mAb group revealed that 64.2% of patients reported meaningful pain relief at 2 hours, and 84.5% had meaningful pain relief 4 hours after taking ubrogepant.” #MigraineChatAMA /12

mdedge.com/neurology/arti…

For a few Qs, there haven’t been studies to provide specific evidence. Sharing w/the #MigraineChat community for personal experiences.

Hair loss on a CGRP preventive and acute tx combo? Able to slow/stop it and stay on both? @xmeatsx (add other tweet)
#MigraineChatAMA /13

More:
Anyone else get neck pain when taking Nurtec?

Experience switching from acute CGRP gepant to preventive? @EJStevensAuthor
#MigraineChatAMA /14

Please do not use thread reader apps to unroll these #MigraineChatAMA threads. They take a lot of research. I don't want others to post/profit off my work. /15

Find these threads helpful? Here are some waays to support #MigraineChat (aside from now accepting tips in my profile) ⬇️ #MigraineChatAMA /16

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