Nurtec vs. Ubrelvy vs. Triptans vs. Zavzpret? Which is Best?

Nurtec vs. Ubrelvy vs. Triptans vs. Zavzpret: Which Migraine Abortive Is Best For You?

Imitrex (Sumatriptan) became available in 1992 as the first of seven triptans for acute migraine treatment. For nearly three decades (1992–2020), no new migraine-specific acute (abortive) medications were introduced. That finally changed in 2020 with two new classes: the gepants (Nurtec ODT/Rimegepant, Ubrelvy/Ubrogepant, and later Zavzpret/Zavegepant nasal spray) and the ditans (Reyvow/Lasmiditan).

So, which abortive medication should you start with for acute migraine attacks? Nurtec vs. Ubrelvy, Ubrelvy vs. triptans, Nurtec vs. triptans, Ubrelvy vs. Zavzpret, Nurtec vs. Zavzpret, triptans vs. Zavzpret, and more? Which has the best efficacy with the fewest side effects? Which is safest for your specific situation and medical conditions? This comprehensive 2026 guide answers these questions with evidence from clinical trials, real-world considerations, and practical guidance from a headache specialist. We compare mechanisms, efficacy (pain freedom and relief at 2 hours and beyond), side effects, dosing, safety (including cardiovascular disease), special populations, cost/access, and how to choose the right option for you.

What Are Migraine Abortives (Acute Treatments)?

Migraine abortive (acute) treatments are taken “as-needed” at the earliest sign of a migraine attack to stop it in its tracks. The goals are:

• Pain freedom or significant pain relief by 2 hours or less
• Resolution of associated symptoms (nausea, photophobia, phonophobia) by 2 hours or less
• Return to normal function (work, social life, etc.) by 2 hours or less
• Minimal to no side effects
• Migraine stays away and does not return within 24 hours

This differs from migraine prevention treatments, which are taken monthly/quarterly (e.g., CGRP monoclonal antibodies (Aimovig, Ajovy, Emgality, Vyepti)); daily gepants like Qulipta/Atogepant or Nurtec every other day, or other daily pills such as specific antidepressant, antiseizure, or blood pressure medicines to reduce frequency and/or severity of attacks.

Without an effective migraine treatment strategy, migraines will often worsen over time in frequency and severity. Therefore, EVERY patient with migraine needs to have an effective acute treatment. If migraine frequency is high enough (4 or more per month), a preventive treatment is also recommended. This blog focuses exclusively on acute options.

History of Acute Migraine Treatments: From Limited Options to New Classes

For centuries, ergotamine was used for migraines, but it had a lot of side effects. Dihydroergotamine (DHE) was derived from ergotamine, developed in 1943 and approved in 1946 for better tolerability, available as IV, injectable, or intranasal — but administration could be cumbersome for some, while side effects still remained an issue for others.

The triptans revolutionized abortive migraine care starting with Imitrex (Sumatriptan) in 1992. Six more followed: Maxalt (Rizatriptan), Relpax (Eletriptan), Zomig (Zolmitriptan), Amerge (Naratriptan), Frova (Frovatriptan), and Axert (Almotriptan). Treximet combines Sumatriptan with naproxen.

Alternatives to triptans historically included over the counter (OTC) NSAIDs/analgesics, and most migraine patients have tried these. Opioids/opiates or butalbital (Fioricet) medications are other older historical classes that were sometimes used. However, opiates and butalbital medications have a high risk of medication overuse headache (rebound headache), and should be avoided as much as possible since they usually make the migraines much worse over time. Neuromodulation devices later added non-drug options.

The 2020 breakthrough: Gepants and ditans arrived. Finally we had new acute migraine medications that were considered safe in patients with cardiovascular disease, vascular disease, cerebrovascular disease, stroke history, or uncontrolled hypertension — contraindications that often rule out triptans and ergots. They also carry no significant risk of medication overuse headache.

Triptans: The Long-Standing Gold Standard Since 1992

Triptans were a major advance over prior limited options. They are discussed in detail in my guide on choosing the right triptan.

How do triptans work: They activate serotonin receptors 5-HT1B and 5-HT1D (serotonin 1B and 1D). This constricts dilated blood vessels (5-HT1B) and prevents CGRP release while disrupting migraine electrical pathways (5-HT1D).

Triptan side effects: Short-lived chest or neck tightness, dizziness, nausea, drowsiness, tingling, or flushing. Imitrex (especially injectable) often has more side effect potential; Maxalt can cause more drowsiness. Most patients tolerate them well.

Key triptan trial data: With 7 triptans available, there have been numerous studies done on each triptan, so we won’t go through all these trials. In general, the triptans showed the following ranges of improvements (variable depending on which triptan was studied). Pain freedom at 2 hours: 18%-50%. Pain relief at 2 hours: 42%-76%. Return to normal function at 2 hours: 30%-60%.

Contraindications and cautions of triptans: Heart disease, vascular disease, cerebrovascular disease/stroke, uncontrolled hypertension. Triptans have historically been considered contraindicated in patients with more rare and severe forms of aura; visual snow syndrome, persistent migraine aura, hemiplegic migraine (migraine with motor aura) and basilar migraine (migraine with brainstem aura). They are considered safe in standard aura (visual, sensory, speech), as long as the duration remains in the normal 5-60 minute range.

When the triptan studies were previously done, 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 (artery narrowing) and lack of blood flow to parts of the brain was the cause of aura symptoms. So the theory was if you caused further artery narrowing with a triptan, it may cause stroke. We now know that this older vascular theory of migraine is defunct and disproven, and that migraine aura symptoms are of an electrical neurological cause (cortical spreading depression), and not a vascular cause.

Actually, during a migraine there is some blood vessel dilation (widens) and the triptans help to mildly constrict the blood vessel back to a smaller diameter. 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 with differing opinions. This gray area comes from theoretical concerns of triptan vasoconstriction resulting in less blood flow to areas of the brain that are metabolically less active and using less blood flow following the transient neurological deficits of migraine aura. Again, the concern is if less blood flow is sent to brain tissue that’s already using less blood flow (following an aura), perhaps it could lead to enough ischemia to cause stroke. However, there’s really been no good evidence for this actually happening. So, the general consensus is to avoid triptans in these specific more rare types of migraine aura noted above if possible.

It’s important to keep in mind that triptans should not be used more than 10 days per month on average. More than this will lead to rebound headache (medication overuse headache), and episodic migraine will eventually transform to chronic migraine. Triptans remain highly effective for most and are often first-line when safe. However, about 30% of migraine patients may not respond very well to them, while others have side effects. So there was still a large void of patients that did not have an effective abortive option, and new treatments were still needed.

The New Classes: Gepants and Ditans (Available Since 2020)

These new migraine abortive classes provide options for triptan non-responders, those with side effects, or patients with cardiovascular or other triptan contraindications. Ubrelvy and Nurtec became available in January and February 2020, respectively. Zavzpret nasal spray became available July 2023. Reyvow became available in January 2020.

Gepants (CGRP Receptor Antagonists): Nurtec ODT, Ubrelvy, Zavzpret

How gepants work: This class of drugs directly block the CGRP (calcitonin gene-related peptide) receptor, thus they are called CGRP inhibitors. During a migraine, trigeminal nerves release CGRP, causing inflammation around the brain and arteries, increased pain signaling, and artery dilation. Gepants reverse vasodilation, decrease trigeminal nerve firing, reduce neurogenic inflammation, and block pain transmission — without causing vasoconstriction (a major difference from triptans). This makes them safe in stable cardiovascular/cerebrovascular disease (although some recommend holding any CGRP antagonists for at least 3 months after an acute stroke). There have also been case reports of high blood pressure or exacerbation of Raynaud’s disease with any type of CGRP antagonist medications (gepants or CGRP monoclonal antibodies).

General advantages: Can combine “stack” with triptans, NSAIDs, DHE, or other acute meds if needed; compatible with CGRP monoclonal antibody preventives; no addiction potential; no medication overuse headache risk; generally excellent tolerability.

Ubrelvy (Ubrogepant): 

-Ubrelvy Side effects (generally similar to placebo): 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%).

-Key trial data: Pain freedom of Ubrelvy vs. placebo: 21% vs 12% at 2 hours; 71% vs. 59% at 4 hours; 83% vs. 70% at 8 hours. Pain relief (moderate/severe pain down to a mild/no pain) of Ubrelvy vs. placebo: 62% vs. 49% at 2 hours; 85% vs. 65% at 4 hours. Return to normal function with Ubrelvy vs. placebo: 64% vs. 49% at 2 hours; 81% vs. 63% at 4 hours; 91% vs. 72% at 8 hours. 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. One study showed that when it is taken early during migraine prodrome, it prevents progression of a headache with moderate to severe pain by nearly 50%. 

-Dosing notes: Oral pill (50 mg or 100 mg) at onset; can repeat a second dose once after 2 hours (max 200 mg/24 hours). Half-life 5–7 hours. Often 10–16 pills/month depending on insurance. AbbVie copay card often $0 for commercial insurance; improving Medicare/Medicaid coverage.

-Best for: Patients wanting a pill option with repeat dosing option, who don’t respond to or cannot take triptans.

Nurtec ODT (Rimegepant): 

-Nurtec Side effects: Very low — nausea 2% (vs 0.4% placebo).

-Key trial data: Pain freedom of Nurtec vs. placebo: 21% vs 11% at 2 hours. Pain relief of Nurtec vs. placebo: 59% vs. 43% at 2 hours. Return to normal function with Nurtec vs. placebo: 9% vs. 7% at 15 minutes; 22% vs. 16% at 1 hour; 38% vs. 26% at 2 hours; 54% vs. 32% at 4 hours. 86% of patients taking Nurtec did not need to take a rescue medication in the following 24 hours.

-Dosing notes: 75 mg orally disintegrating tablet (dissolves on tongue in seconds, no water needed, mint flavor) at onset. One dose per 24 hours (not repeated). Half-life ~11 hours (longer-lasting). Also FDA-approved for prevention (every other day). Typically 8–16 pills/month depending on insurance. Pfizer copay card often $0 for commercial insurance, improving Medicare/Medicaid coverage.

-Best for: Patients who want no-water convenience, longer duration, dual acute + preventive option, or triptan non-responders or can not use triptans, lowest side effect profile of any abortive migraine meds.

Zavzpret (Zavegepant) Nasal Spray: 

-Zavzpret Side effects: Taste disturbance (~21% vs 5% placebo), nasal discomfort (~23% vs 5%), nausea (~20% vs 7%).

-Key trial data: Pain freedom of Zavzpret vs. placebo: 24% vs 15% at 2 hours. Pain relief of Zavzpret vs. placebo: 59% vs. 50% at 2 hours. Pain relief as early as 15 minutes; sustained relief up to 48 hours in some measures. 

-Dosing notes: 10 mg nasal spray (one spray in one nostril) at migraine onset. One dose per 24 hours. Half-life 5–8 hours. Fastest-onset gepant. Typically 6 sprays/treatments/month. Pfizer copay card often $0 for commercial insurance, improving Medicare/Medicaid coverage.

-Best for: Waking with migraine, fast onset migraine, nausea/vomiting (can’t keep pills down), need for fastest onset, or pill aversion.

Ditans: Reyvow (Lasmiditan)

How ditans work: Selective 5-HT1F (serotonin 1F) receptor agonists. They inhibit release of inflammatory neurotransmitters and neuropeptides (including CGRP) from trigeminal nerves and interfere with other pain pathways — without vasoconstriction. Safe in cardiovascular and cerebrovascular disease similar to gepants. Caution with other serotonergic drugs (serotonin syndrome risk is rare). No rebound headache risk. Can combine with gepants.

Reyvow (lasmiditan): 

-Reyvow Side effects (higher than gepants): Dizziness (9–17% depending on dose vs ~3% placebo), paresthesias/tingling (3–9%), somnolence/sedation (6–7%), nausea (3–5%), fatigue. Important warning: Impairs driving and machinery operation for at least 8 hours after dosing (one study showed impairment up to 1.5+ hours; official guidance is to wait 8 hours).

-Key trial data: Strong efficacy, including in triptan non-responders. Pain freedom of Reyvow vs. placebo: 28-39% vs. 8-21% at 2 hours. Pain relief of Reyvow vs. placebo: 65% vs. 41% at 2 hours. Return to normal function of Reyvow vs. placebo: 38-40% vs. 22-25% at 2 hours.

-Dosing notes: 50 mg, 100 mg, or 200 mg oral tablets at onset. One dose per 24 hours (max 200 mg). Half life 5.7 hours.Limited to 8 pills/month. Eli Lilly copay card often $0 for some commercial insurances.

-Best for: Gepant or triptan non-responders (especially those with vascular issues) who can plan around the driving restriction and tolerate potential dizziness/sedation. A study showed Reyvow superior to placebo in patients who previously did not respond to triptans (strong pain freedom and relief data starting early).

OF NOTE: Eli Lilly voluntarily discontinued the production of Reyvow for business reasons, rather than due to any safety or efficacy concerns, on May 31st, 2026.

Head-to-Head Comparisons: Efficacy and Side Effects (Evidence from Major Analyses)

A large analysis and systematic review of 64 double-blind randomized controlled trials compared gepants (Nurtec, Ubrelvy), ditans (Reyvow), and triptans. To clarify, these medications weren’t compared all together head-to-head in one single study, but rather data from multiple studies for each medicine were compared.

Key findings:

• Most triptans showed higher likelihood of pain freedom and significant pain relief at 2 hours compared to Reyvow, Nurtec, and Ubrelvy.
• No statistically significant differences in pain freedom or pain relief at 2 hours between Reyvow, Nurtec, and Ubrelvy.
• Side effects: Reyvow had the highest rates of side effects. Some triptans (e.g., Imitrex/sumatriptan, Maxalt/rizatriptan, Zomig/zolmitriptan) had higher side effect risk than gepants. Gepants had the lowest side effect rates overall.

All options are superior to placebo. Triptans often edge out on raw 2-hour efficacy in aggregated data, while gepants shine on tolerability and safety profile. Individual response varies greatly due to differences in predominating migraine pathways between patients.

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.

Which Migraine Abortive Medicine Is Best for You? Practical Guidance for the Most Effective Treatment

• Start with triptans (if no contraindications) — often most effective for many. However, about 30% of patients with migraine may be triptan non-responders.
• Try gepants if triptans fail, cause side effects, or you have cardiovascular risks or other medical contraindications. Excellent tolerability and fewer side effects than triptans; Nurtec for convenience/dual acute and preventive use; Ubrelvy for repeat dosing after 2 hours or if you prefer an oral tablet over a dissolvable tablet; Zavzpret for speed/nausea.
• Consider Reyvow for triptan and gepant non-responders who can manage dizziness and driving restrictions. However, this is currently no longer available and has been discontinued (unless another company brings it back to market).
• Everyone’s migraines differ — one person may find a gepant “miraculous” after triptan failure; the reverse is also common. Work with a headache specialist to trial options systematically to see what “clicks” for you.
• Combine classes when appropriate (e.g., gepant + triptan or NSAID).
• No rebound headache risk with gepants/ditans is a major advantage for frequent users.

Safety in Pregnancy, Breastfeeding, and Other Populations

Limited data exists on gepants and ditans in pregnancy/breastfeeding, so they are generally not recommended until more data is collected. Small fractions of Nurtec and Ubrelvy appear in breast milk (likely clinically negligible per some analyses), but caution advised. Triptans (especially sumatriptan) are often considered compatible with breastfeeding by specialists when benefits outweigh risks. They are generally avoided in pregnancy per labeling but used selectively by some experts. All newer options of gepants and ditans are safe regarding cardiovascular vasoconstriction risks.

Summary

The landscape of treatment options for the acute treatment of migraine has dramatically improved since 2020. Between triptans, gepants, and ditans, most patients can find an effective, well-tolerated option. Overall, these medications are all very effective medications for the treatment of acute migraine with strong supporting evidence from clinical trial results. 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 as well. 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.

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