Migraine : Rimegepant indications and recommendations for prophylaxis

The table outlines the classification of migraines, the specific indication for Rimegepant (Vydura, Pfizer) in migraine prevention, and the associated recommendations for its use. It provides a concise summary of guidelines, helping clinicians make informed decisions about migraine treatment and patient management.

Section	Information
Migraine Classification	Migraine can be classified as episodic or chronic. • Episodic migraine: Fewer than 15 headache days a month. • Chronic migraine: 15 or more headache days a month with at least 8 of those having features of migraine.
Marketing Authorisation Indication	Rimegepant (Vydura, Pfizer) is indicated for the 'preventative treatment of episodic migraine in adults who have at least 4 migraine attacks per month'.
Recommendations	○ Rimegepant is recommended as an option for preventing episodic migraine in adults who have at least 4 and fewer than 15 migraine attacks per month, only if at least 3 preventative treatments have not worked. ○ Preventative treatments include topiramate, propranolol, and amitriptyline. Fourth-line treatments on the NHS include erenumab, fremanezumab, and galcanezumab. ○ Stop rimegepant after 12 weeks of treatment if the frequency of migraine attacks does not reduce by at least 50%. ○ If rimegepant is considered suitable, use the least expensive option taking into account...

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