Nurtec vs. Ubrelvy vs. Zavzpret vs. Reyvow vs. Triptans. What are the differences and which is best?
Imitrex (Sumatriptan) became available in 1992 and was the first of seven triptans available. From 1992 to 2020, we had no new migraine headache specific abortive medicines produced. This FINALLY changed in 2020 when two new classes of migraine abortive medicines became available with the gepants (Nurtec, Ubrelvy, Zavzpret) and the ditans (Reyvow).
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With all of these new migraine abortive medications in addition to the triptans, how do you know which class to start with for your head pain? Which might be the best choice for you with the least side effects? This blog will help you and your doctor with these questions.
We’ll also review the highlights of a large publication that compared the effectiveness and side effects of gepants (Nurtec, Ubrelvy) vs. triptans (Imitrex, Maxalt, etc.) vs. ditans (Reyvow) with surprising results. More to come on that shortly. First, let’s make sure you understand how these various migraine treatments work and what their differences are.
What Are Migraine Abortives?
Migraine abortive (acute) treatments are made to stop migraine attacks as soon as they start. These are “as-needed” medicines taken at the earliest sign of a migraine attack. In other words, they are made for the acute treatment of migraine. The goal of abortive medications is pain freedom, or significant pain relief, along with resolution of migraine-associated symptoms of nausea, sensitivity to light and sound at 2 hours or sooner. Ultimately, the goal is to fully restore your function rather than having to miss work, social events, or other plans by spending the whole day in bed.
This is in contrast to migraine prevention treatments which are a continuous daily treatment. Preventive treatments include a daily pill, a monthly/quarterly treatment such as CGRP monoclonal antibodies (Aimovig, Ajovy, Emgality, Vyepti), or neuromodulation devices. The goal of migraine preventive treatment is to lessen the frequency and/or severity of migraine attacks.
If you have migraine, you want to have both a good acute migraine treatment and preventive migraine treatment plan to lessen migraine’s nasty habit of interfering and disrupting life and function. Today’s blog will be focusing only on the new migraine abortive medications compared to the triptans.
What are the newest migraine abortive medications and what came before them?
Migraine abortive options have always been limited up until recent years. For centuries, the ergots (ergotamine) had been used for migraines and as a pharmaceutical since 1926 (ergotamine, cafergot), although these had many bad side effects. In 1943, dihydroergotamine (DHE) was synthesized from ergotamine, and approved for migraine use in the US in 1946. The goal of this semi-synthetic form of ergotamine was for better effectiveness and less side effects than ergotamine. It did achieve these goals, but was only available in IV and injectable forms, and later intranasal. So one major downside of DHE has always been the more difficult route of drug administration.
Then came the triptans, first with Imitrex (Sumatriptan) in 1992. 6 additional triptans followed with Maxalt (Rizatriptan), Relpax (Eletriptan), Zomig (Zolmitriptan), Amerge (Naratriptan), Frova (Frovatriptan), and Axert (Almotriptan). Treximet is an 8th triptan variation made of Sumatriptan combined with Naproxen.
The alternatives to triptans have historically been an older medicine class called the ergots (ergotamine, DHE) which can be complicated to use, tend to have an excess of side effects for many, and have the same medical contraindications as triptans. NSAIDs and over the counter analgesics are also commonly used, although many do not respond to or cannot take them due to other medical conditions. Even worse are opiates/opioids and butalbital medications such as fioricet, both of which (as do excess triptans, NSAIDS, OTCs) have a high risk of leading to medication overuse headache (rebound headache). For close to 3 decades, these have remained the only limited options of acute/abortive migraine treatment, despite migraine being such a widespread common disorder! More recently, neuromodulation devices have also become available as abortive options.
Thankfully, these limited options have now expanded to 4 new migraine abortive options in adults between 2 new classes which became available commercially in 2020; the gepants and the ditans. These medications can be used SAFELY in all of the medical contraindications mentioned above, including cardiovascular disease! These new medications for migraine patients are compared with one another, as well as with the triptans in the table below.
Triptans
The triptans were a major step forward from the very limited preexisting options of over the counter NSAIDs and analgesics, ergotamine, and DHE. Triptans are a further refinement of DHE having even less side effect potential and targeting only 2 migraine receptor targets in the brain, as opposed to DHE which targets multiple receptors. Triptans work well for many people. However, about 30% of patients do not respond to triptans. So even after the triptans, there was still a large void of patients that did not have an effective abortive option. The triptans are discussed in much greater detail here, including how to choose which one to try first.
How do the triptans work?
Triptans activate 2 different serotonin sub-receptors (HT1B, HT1D) which cause dilated blood vessels to constrict (narrow) at 5HT1B and prevent CGRP release along with disruption the electrical pathways involved in a migraine attack at 5HT1D.
What are the side effects of the triptans?
The most common side effects of Imitrex (Sumatriptan) and other triptans include a short duration sense of chest or neck tightness, dizziness, nausea, drowsiness, tingling or flushing sensations. Clinically, Imitrex tends to usually have the most potential for side effect (particularly the injectable version), while Maxalt (Rizatriptan) tends to sometimes have more drowsiness associated with it. With that said, the vast majority of patients tend to tolerate triptans very well.
Others cannot use triptans because of medical contraindications and safety concerns related to potential blood vessel narrowing such as heart disease, vascular disease, cerebrovascular disease, stroke, or uncontrolled blood pressure.
Triptans are also contraindicated in patients with visual snow, persistent migraine aura, and migrainous stroke (infarction). Triptans have been historically contraindicated in hemiplegic migraine (now called migraine with motor aura) or basilar migraine (now called migraine with brainstem aura). This was based on theoretical concerns of vasoconstriction potentially causing stroke in areas of the brain that were already metabolically less active and using less blood flow during the transient neurological deficits of aura. When the triptan studies were done previously, they excluded patients with these forms of migraine due to the ongoing vascular theory of migraine at that time. The vascular theory of migraine assumed that vasoconstriction and lack of blood flow was the only cause of aura and neurologic features with migraine. So the thinking was that if you cause further vasoconstriction with a triptan, you may cause stroke. However, we now know that migraine aura symptoms are primarily of an electrical basis and not a vascular basis. Therefore some headache specialists have gotten more comfortable with the use of triptans in patients with these forms of migraine, but it is still a bit of a gray area.
Gepants
The gepants were the first new class of medications (CGRP antagonists) to emerge as a migraine abortive. Ubrelvy (Ubrogepant) first became available in the United States in January 2020 and Nurtec (Rimegepant) followed in February 2020. In July 2023, the first nasal spray abortive gepant called Zavzpret (Zavegepant), became available.
How do the gepants work?
These new treatment options precisely target an important step in the pathophysiology of migraine. During a migraine attack, the trigeminal nerves release a variety of inflammatory proteins, one of which is called CGRP (calcitonin gene-related peptide). CGRP causes 3 major events involved in a migraine. It causes inflammation around the brain and cerebral arteries (“sterile inflammation”), increased transmission of pain signals through the trigeminal nerves into the brainstem and into the brain, and dilation of the cerebral arteries traveling through the meninges surrounding the brain. The result of these 3 steps is intense migraine pain. So, if we can block these steps of migraine pain, the attack should be aborted quickly, and the pain not as severe.
Gepants work as CGRP receptor antagonists, which means they directly target and block (antagonist) the CGRP receptor. This results in the medication “blocking” the CGRP inflammatory protein from sticking to the CGRP receptor to activate it, and thus prevents it from “turning on” these migraine pathways. So, you get reversal of cerebral vasodilation, which decreases the firing off of the trigeminal nerves. Notably, the gepants do this in a way that does not cause vasconstriction (artery narrowing), in contrast to the triptans which do. Thus, gepants are felt to be safe in those with cardiovascular or cerebrovascular disease (as opposed to the triptans and DHE). By blocking the CGRP receptor, you also get reversal of the neurogenic inflammation going on through the brain and around the arteries, and you block the electrical transmission of migraine pain from traveling from the trigeminal nerves into the brain.
How are the abortive gepants used?
Nurtec, Ubrelvy, and Zavzpret are used the same as any other migraine abortive. The sooner the medicine is taken in the beginning of a migraine attack, the more effective it will. Gepants can also be combined and used with triptans, NSAIDs, DHE, or other acute meds together. Gepants can also be used in combination with the preventive CGRP receptor antagonist monoclonal antibodies (mAbs) (Emgality, Ajovy, Aimovig, Vyepti). Gepants are not associated with addiction potential, and do not cause medication overuse headache (rebound)! Compared to the triptans and DHE, gepants are not contraindicated in patients with cardiovascular or peripheral vascular disease or risk factors because they do not cause narrowing of the arteries, which is a HUGE benefit. In general, the gepants have significantly fewer side effects compared to many of the earlier abortive medication options.
Ubrelvy (Ubrogepant)
Ubrelvy was the first gepant that came to market in January 2020. It is a quick acting abortive pill. It is taken at migraine onset, and can be repeated once if needed after 2 hours (similar to triptan dosing). Ubrelvy is unique in that it is the only gepant in which you can repeat a 2nd dose if needed after 2 hours. It normally comes in 16 pills per month, although some plans still only allow 10 pills. The half life of Ubrelvy is 5-7 hours.
Ubrelvy clinical trial results
The primary endpoint of the study was pain freedom at 2 hours. Ubrelvy was statistically superior to placebo for complete pain relief at 2 hours in 21% vs. 12% placebo. 71% were pain free by 4 hours vs. 59% placebo, and 83% by 8 hours vs. 70% placebo. Notably, Ubrelvy was similarly effective whether taken right away at migraine onset or up to 4 hours after it began, which means you have more flexibility in catching the attack if you miss the early stage, as opposed to triptans.
The secondary endpoint of the study was pain relief at 2 hours. This means pain has moved from a moderate to severe level of pain down to a mild or no level of pain. Ubrelvy was statistically superior to placebo for pain relief at 2 hours in 62% vs. 49% placebo. Even at 1 hour, Ubrelvy became statistically superior to placebo for pain relief in 43% vs. 37% placebo.
The study also assessed the return to normal function by 2 hours with Ubrelvy. 64% of patients had normal function restored by 2 hours vs. 49% placebo, 81% at 4 hours vs. 63% placebo, and 91% at 8 hours vs. 72% placebo. Ubrelvy was also statistically superior to placebo for freedom from most bothersome migraine symptom (nausea, photophobia or phonophobia) at 2 hours. These improvements continued into 48 hours.
A more recent study showed that by taking Ubrelvy 100 mg during pre-headache prodrome symptoms, 46% were able to prevent the subsequent migraine from reaching a moderate to severe pain level (compared to 29% of placebo). So by taking it early, they were more than 2x as likely to avoid moderate to severe level pain. Migraine prodrome symptoms are very early signs that a migraine is coming which may occur hours or even a day or so before the attack hits. Common migraine prodrome symptoms are brain fog, dizziness, drowsiness, nausea, neck pain/stiffness, and increased light sensitivity.
Ubrelvy side effects
Side effects of Ubrelvy were similar to placebo and the most common were nausea (placebo 2%, 50 mg 2%, 100 mg 4%), somnolence (sleepiness) (placebo 1%, 50 mg 2%, 100 mg 3%), and dry mouth (placebo 1%, 50 mg <1%, 100 mg 2%).
Ubrelvy cost / Ubrelvy coupon
Abbvie offers a $0 copay card which works with most commercial insurance plans. The card is available from the website, or your doctor’s office may have them. Medicare and Medicaid plans are covering Ubrevly better now as well.
Nurtec ODT (Rimegepant)
Nurtec ODT was the 2nd abortive gepant which came to market one month after Ubrevly in February 2020. It is an orally disintegrating tablet (ODT) which dissolves on the tongue in seconds, and also starts working very quickly (15 minutes in some patients). It does not require water or other liquids to take with the dose, so it can be taken anytime and anywhere. It comes in one strength of 75 mg and has a pleasant mint flavor. It is taken at the onset of migraine, but only once per day as needed. The dose is not repeated as it can be with Ubrelvy. It comes in 16 pills per month, although some plans still only allow 8 pills.
Nurtec is unique in that it was also FDA approved in May 2021 as a migraine preventive taken every other day, and that is discussed in more detail here. The half life of Nurtec is 11 hours, which is why it was dosed as an every other day treatment in the migraine preventive trial.
Nurtec clinical trial results
The primary endpoint of the study was pain freedom at 2 hours. Nurtec was statistically superior to placebo for complete pain relief at 2 hours in 21% vs. 11% placebo. The study also included a coprimary endpoint of freedom from most bothersome migraine symptom at 2 hours (nausea, photophobia, or phonophobia). 35% reported resolution of their most bothersome migraine symptom by 2 hours with Nurtec vs. 27% of placebo.
The secondary endpoint of the study was pain relief at 2 hours. Nurtec was statistically superior to placebo at 2 hours for pain relief in 59% vs. 43% in placebo. 86% of patients taking Nurtec did not need to take a rescue medication in the following 24 hours.
The study also assessed the return to normal function after treatment. At 15 minutes, 9% were back to normal function vs. 7% of placebo. At 1 hour, 22% taking Nurtec were back to normal function vs. 16% in placebo. At 2 hours, 8% were back to normal function with Nurtec vs. 26% in placebo. At 4 hours, 54% were back to normal function vs. 32% in placebo.
Nurtec side effects
Side effects of Nurtec were similar to placebo and the most common side effect was nausea (placebo 0.4%, Nurtec 2%).
Nurtec cost / Nurtec coupon
Pfizer offers a $0 copay card which works with most commercial insurance plans. The card is available from the website, or your doctor’s office may have them. Medicare and Medicaid plans are covering Nurtec better now as well.
Zavzpret Nasal Spray (Zavegepant)
Zavzpret is the newest abortive gepant and it came to market in July 2023. Zavzpret is the first and only abortive nasal gepant, so it is the fastest acting gepant. It is also a great choice for those with waking migraine, nausea and vomiting (where a pill won’t stay down), fast onset migraine, and for those that can’t take a pill. It comes in a single dose of 10 mg. Zavzpret dosing is performed by one spray in one nostril in a “nose to toes” position (point nose towards floor and spray straight up into a nostril). One dose per 24 hours is allowed (it is not repeated). Zavzpret comes in 6 sprays (6 treatments) per month. The half life of Zavzpret is 5-8 hours.
Zavzpret clinical trial results
The primary endpoint of the study was pain freedom at 2 hours. Zavzpret was statistically superior to placebo for complete pain relief at 2 hours in 24% vs. 15% in placebo. The study also included a coprimary endpoint of freedom from most bothersome migraine symptom at 2 hours (nausea, photophobia, or phonophobia). 40% reported resolution of their most bothersome migraine symptom by 2 hours with Zavzpret vs. 31% of placebo.
The secondary endpoint of the study was pain relief at 2 hours. At 2 hours, 59% had significant pain relief vs. 50% of placebo. Return to normal function could be seen as early as 30 minutes. 36% had restored normal function at 2 hours vs. 26% of placebo. 36% had sustained pain relief at 48 hours vs. 30% of placebo. Pain relief was seen as quick as 15 minutes and could last 48 hours. There were many other secondary endpoints, but I think these are the most important.
Zavzpret side effects
In the study, side effects of Zavzpret included taste disturbance in 21% vs. 5% of placebo, nasal discomfort in 23% vs. 5% of placebo, and nausea in 20% vs. 7% of placebo.
Zavzpret cost / Zavzpret coupon
Pfizer offers a $0 copay card which works with most commercial insurance plans. The card is available from the website, or your doctor’s office may have them. In addition, the first 2 prescription fills are free with most commercial insurance plans.
Ditans
The ditans are another new class of migraine abortive, premiering with Reyvow (Lasmiditan) in January 2020. Currently, there is only one medicine available in this class (Reyvow).
How does Reyvow work (and the ditans)?
Reyvow acts as a 5-HT1F (serotonin 1F) receptor agonist (so it activates this receptor). It helps to stop the release of inflammatory pain producing neurotransmitters and neuropeptides including CGRP from the trigeminal nerves during a migraine attack. These receptors are also involved in interfering with other migraine pain pathways. Notably, like the gepants, they also do not cause arterial vasoconstriction. Again, this is a tremendous benefit and another great option in patients who may not be able to use triptans due to medical contraindications such as coronary or peripheral vascular disease.
Caution should be used with other serotonergic drugs given a potential for serotonin syndrome, which has been rarely reported. The current consensus is that Reyvow and the ditan class do not cause rebound headache (medication overuse headache) either, similar to the gepants. Reynow can also be used in combination with the gepants if needed.
Reyvow (Lasmiditan)
Reyvow comes in 50 mg, 100 mg, and 200 mg. It is taken at the migraine onset and is only used once per 24 hours (it is not repeated within the same 24 hours). The half life of Reyvow is about 5.7 hours.
Reyvow clinical trial results
The primary endpoint of the study was pain freedom at 2 hours. Reyvow was statistically superior to placebo for complete pain relief at 2 hours in 32.2% with 200 mg vs. 28.2% with 100 mg vs. 15% placebo. Actually, superiority over placebo occurred earlier than expected at 1 hour with 200 mg and 1.5 hours with 100 mg doses. The study also included a coprimary endpoint of freedom from most bothersome migraine symptom at 2 hours (nausea, photophobia, or phonophobia). 41% reported resolution of their most bothersome migraine symptom by 2 hours with both 200 mg and 100 mg doses vs. 29.5% of placebo.
The secondary endpoint of the study was pain relief at 2 hours. Reynow was statistically superior to placebo at 2 hours for pain relief in 59.5% with 200 mg vs. 59.4% with 100 mg vs. 42.2% in placebo.
Reyvow side effects
Side effects in the study included dizziness (placebo 3.4%, 100 mg 12.5%, 200 mg 16.3%), tingling (paresthesias) (placebo 2.1%, 100 mg 5.7%, 200 mg 7.9%), somnolence (sleepiness) (placebo 2.3%,100 mg 5.7%, 200 mg 5.4%), nausea (placebo 1.9%,100 mg 3%, 200 mg 5.3%), fatigue (placebo 0.3%,100 mg 4.1%, 200 mg 3.1%).
In a driving study, 50 mg, 100 mg, or 200 mg doses of Reyvow significantly impaired subjects’ ability to drive, especially at 1.5 hours post-dose vs. placebo. This effect was no longer observed after 8 hours. Therefore, patients should wait at least 8 hours between dosing and driving or operating machinery. This can certainly be a drawback in terms of being a treatment option for many patients as the goal of abortive therapy is partly to be able to maintain and restore function in order to not disrupt work, plans, etc. However, if you are in a position where this would not be an issue for you, it could certainly be a valid option to have in your migraine war chest. It should also be used with caution in combination with alcohol or other central nervous system depressants.
Reyvow is a Schedule V controlled substance compared to the other abortive options. Schedule V represents the lowest abuse potential category from the DEA. The reason is because in a human abuse potential study, doses of 100 mg, 200 mg, and a supratherapeutic dose of 400 mg were associated with statistically significantly higher “drug liking” scores than placebo, indicating possible abuse potential. However, it had statistically significantly lower “drug liking” scores compared to alprazolam 2 mg. Lasmiditan also produced adverse events of euphoria and hallucinations to a greater extent than placebo, although it was a low frequency (about 1% of patients).
Reyvow cost / Reyvow coupon
Lilly offers a $0 copay card which works with most commercial insurance plans. The card is available from the website, or your doctor’s office may have them.
The Gepants (Nurtec, Ubrelvy, Zavzpret) vs. Triptans (Imitrex, Maxalt, Relpax, Zomig, Amerge, Frova, Axert) vs. Ditans (Reyvow). Which works the best, and has the least side effects?
These are very common questions, and we finally have a study that helps to answer some of these questions! There was a large study published that compared all of the double-blind randomized clinical trials (64 trials) of Nurtec, Ubrelvy, Reyvow, and all of the triptans. The main goal of the study was comparing how effective each medicine was in providing pain freedom (headache completely gone) or pain relief (maybe not gone, but improved significantly from severe to mild pain) at 2 hours. Results showed that most triptans were associated with a higher likelihood of both pain freedom and significant pain relief at 2 hours compared with Reyvow, Nurtec, and Ubrelvy. Comparisons between Reyvow, Nurtec, and Ubrelvy showed no statistically significant differences in pain freedom or pain relief at 2 hours between them.
The study also compared side effects between these medicines. Reyvow had the highest chance of side effects, and some triptans including Imitrex (Sumatriptan), Maxalt (Rizatriptan), and Zomig (Zolmitriptan) also had a higher risk of side effects than the gepants (Nurtec, Ubrelvy).
In summary, the study reported that gepants and ditans were associated with less effectiveness compared with triptans, whereas gepants had the least side effects compared with triptans and ditans.
There was another study that reported that in patients who did not respond to triptans, Reyvow was superior to placebo in these triptan non-responders for pain freedom at 2 hours (placebo 8.8%, 100 mg 24%, 200 mg 25.6%) beginning at 1 hour for both 100 and 200 mg doses. Reyvow was also superior for pain relief by 2 hours in these patients (placebo 39.9%, 100 mg 60.1%, 200 mg 64.5%) with pain relief beginning at 30 minutes (200 mg) or 1 hour (100 mg), as well as most bothersome migraine symptom freedom at 2 hours (placebo 29.1%, 100 mg 40%, 200 mg (34.8%).
The chart at the bottom compares and contrasts the treatment outcomes data between Nurtec, Ubrelvy, Reyvow, and Imitrex. The source of the data comes from the trials of each medication. This data is not reflective of head to head trials between these medications. It is derived from separate independent trials, of which there may have been variations in study design and endpoints. In addition, the older triptan studies did not include some of the treatment outcome data points that have become standard in newer abortive medication trials. Regardless, I have highlighted some of the key differences in bold print.
Can gepants, ditans, and triptans be used in pregnancy or breastfeeding?
There is not enough data on the safety of the gepants or ditans in pregnancy or breastfeeding, and therefore they are not recommended. There have been studies published showing that the amount of Nurtec and Ubrelvy that enters the breast milk is a very small fraction of the dose and felt to likely be clinically negligible. Regardless, further data is needed before definitively reporting them to be safe. Sumatriptan (Imitrex) and the triptans are generally felt to be safe in breastfeeding by most headache specialists at this point (preferably with Sumatriptan). During pregnancy triptans are still generally avoided, although a lot of specialists are starting to use them occasionally during pregnancy if the benefit outweighs the risk, although the package insert still reports that it should be avoided.
Summary
Overall, the triptans, gepants, and ditans are all very effective medications for the treatment of acute migraine. All of these options have been proven to be superior to placebo at 2 hours for pain freedom and/or pain relief, so there is no “bad” option.
It’s important to keep in mind that everyone’s migraines may have variations in which electrical pathways are predominantly influencing their migraine attacks. This is why one person responds amazingly well to one medicine while the next person has no response to it. I’ve seen patients that had no response to multiple triptans feel like a gepant was a miracle drug for them, while I’ve seen the reverse of this just as often. Therefore, if one class of medicine doesn’t help, it’s always worth talking to your headache specialist or healthcare provider to try a different class of medicine until you find the one that “clicks” with your migraine circuitry to eliminate your migraine symptoms consistently and effectively.
| Rimegepant | Ubrogepant | Lasmiditan | Sumatriptan (100 mg) | |
|---|---|---|---|---|
| Class | Gepant | Gepant | Ditan | Triptan |
| Mechanism of Action | CGRP receptor antagonist | CGRP receptor antagonist | 5HT1F agonist | 5HT1B and 5HT1Dagonist |
| Available dosing | 75 mg orally dissolvable tablet | 50 mg, 100 mg pill | 50 mg, 100 mg, 200 mg (100 mg x 2) pill | 25 mg, 50 mg, 100 mg pill; 3 mg, 4 mg, 6 mg injection; 5 mg, 10 mg, 20 mg nasal spray |
| Max dose per 24 hours | 75 mg | 200 mg | 200 mg | 200 mg |
| Pills per prescription (standard, may be more depending on insurance) | 8 | 10 | 8 | 9 |
| Dosing frequency | 1 dose/24 hours | Dose can repeated once in 2 hours; 2 doses/24 hours | 1 dose/24 hours | Dose can repeated once in 2 hours; 2 doses/24 hours |
| Suggested number of migraine attacks treated per 30 days | 15 (however, currently also being studied as a daily preventive) | 8 | 4 | 10 |
| Time to reach statistically significant pain relief | 60 minutes (however, there was a 15 minute measured clinical beneficial effect) | 60 minutes with 50 mg or higher doses | 30 minutes with 100 mg or higher doses; 60 minutes with 50 mg dose | 30 minutes with 50 mg or higher doses |
| 1 hour significant pain relief | 37% 31% (placebo) | 43% (50 mg) N/A (100 mg) 36.7% (placebo) | 37.3% (50 mg) »41% (100 mg) »46% (200 mg) 30.6% (placebo) | 20-35% (100 mg) 12-21% (placebo) |
| Differences in pain relief at 15 minutes | 8% 5% (placebo) | N/A | N/A | N/A |
| Differences in pain relief at 30 minutes | 19% 17% (placebo) | 19% (50 mg) N/A (100 mg) 20% (placebo) | »15% (50 mg) 17.5% (100 mg) 19.1% (200 mg) 13.4% (placebo) | 11% (100 mg) 12% (placebo) |
| 2 hour pain relief | 59% 43% (placebo) | 61.7% (50 mg) 61.4% (100 mg) 48.7% (placebo) | 59% (50 mg) 59.4-64.8% (100 mg) 59.5-65% (200 mg) 42.2-47.7% (placebo) | 46-67% (100 mg) 18-44% (placebo) |
| 2 hour pain freedom | 21% 11% (placebo) | 20.5% (50 mg) 21.2% (100 mg) 13% (placebo) | 28% (50 mg) 28-31% (100 mg) 32-39% (200 mg) 15-21% (placebo) | 22-33% (100 mg) 3-13% (placebo) |
| 8 hour pain freedom with 1 dose | 56% 33% (placebo) | 82.3% (50 mg) 82.7% (100 mg) 69.8% (placebo) | N/A | N/A |
| 8 hour pain relief with 1 dose | 74% 56% (placebo) | 92% (50 mg) N/A (100 mg) 82% (placebo) | N/A | N/A |
| % of patients with 1st dose pain relief who achieved pain freedom after 2nddose | N/A | 54.7% (50 mg/50 mg) 33.3% (50 mg/placebo) 51.6% (100 mg/100 mg) 33.3% (100 mg/placebo) | N/A | N/A |
| Sustained pain freedom 2-24 hours | 15.7% 5.6% (placebo) | 13.6% (50 mg) 15.4% (100 mg) 8.4% (placebo) | 17.2% (50 mg) 14.8-17.9% (100 mg) 18.6-22.7% (200 mg) 7.6-13.4% (placebo) | N/A |
| Sustained pain relief 2-48 hours | 47.8% 27.7% (placebo) | 31.5% (50 mg) 34% (100 mg) 17.5% (placebo) | N/A | N/A |
| 2 hour absence of most bothersome migraine symptom | 35% 27% (placebo) | 38.7% (50 mg) 37.7% (100 mg) 27.6% (placebo) | 41% (50 mg) 41-44% (100 mg) 41-49% (200 mg) 30-33% (placebo) | N/A |
| 8 hour absence of most bothersome migraine symptom | N/A | 90.9% (50 mg) 92.4% (100 mg) 77.7% (placebo) | N/A | N/A |
| Time to peak plasma concentration TMAX | 1.5 hours | 1.5 hours | 1.8 hours | 1.5-2.5 hours |
| ½ life | 11 hours | 5-7 hours | 5.7 hours | 2-2.5 hours |
| Time to reach pharmacologically active concentration | 15 minutes | Within 11 minutes | N/A | N/A |
| Time the pharmacologically active concentration is maintained | 48 hours | 12 hours | N/A | N/A |
| Notable side effects | Nausea 2% 0.4% (placebo) | Nausea 2% (50 mg) 4% (100 mg) 2% (placebo) Somnolence/Sedation 2% (50 mg) 3% (100 mg) 1% (placebo) | Nausea 3% (50 mg) 4% (100 mg) 4% (200 mg) 2% (placebo) Somnolence/Sedation 6% (50 mg) 6% (100 mg) 7% (200 mg) 2% (placebo) Dizziness 9% (50 mg) 15% (100 mg) 17% (200 mg) 3% (placebo) Paresthesias 3% (50 mg) 7% (100 mg) 9% (200 mg) 2% (placebo) | Widely variable, most common: Dizziness, fatigue, paresthesias, sedation, nausea, palpitations, anxiety, muscle tightness sensation in chest/neck/throat |
IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!
FIRST, LET’S DECIDE WHERE TO START:
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