rimegepant effectiveness and tolerability as migraine preventive treatment

Conditions: Migraine; Migraine With Aura; Migraine Without Aura; Chronic Migraine

Summary: the purpose of this prospective and multicentric study is to evaluate the effectiveness and tolerability of rimegepant as preventive migraine treatment in a cohort of episodic or chronic migraine patients.

rimegepant belongs to the gepants family, small molecules calcitonin gene- related peptide (cgrp) receptor antagonists. it is a new generation gepant, currently available as an orally disintegrating tablet at a single dose of 75 mg. it has a double indication both for acute treatment for migraine with and without aura and preventive treatment of migraine. a previous randomized, placebo-controlled phase 2/3 trial demonstrated its effectiveness and tolerability in the preventive setting for patients with episodic and chronic migraine. previous studies also demonstrated a good tolerability profile. the most commonly reported adverse events were nausea, nasopharyngitis, upper respiratory tract infections and urinary tract infections. in this prospective multicentric study the investigators aim to evaluate rimegepant effectiveness and tolerability as preventive migraine treatment in a real-world setting. subjects who meet the inclusion criteria will be enrolled and will participate in the study. baseline demographic and clinical data will be collected at the baseline visit. the observation period will last for two years during which patients will take rimegepant 75 mg orally disintegrating tablet every other day for a time period related to eventual approval of reimbursability criteria. data will be collected at baseline and every three months for two years. subjects will be asked to keep a headache diary to collect monthly headache and migraine days, migraine severity, associated symptoms and drug consumption. questionnaires will be collected every three months. data collection will focus on: i) demographic data, ii) migraine history, iii) pain intensity, iv) presence and evolution of migraine associated symptoms and aura, v) migraine associated disability, vi) tolerability and eventual treatment- emergent adverse events, vii) treatment persistence, viii) questionnaires related to disability, allodynia, quality of life, interictal burden and effectiveness of the ongoing acute and preventive treatments. the online database redcap will be used for data collection.

Eligibility criteria:
inclusion criteria: * diagnosis of migraine without aura, migraine with aura, or chronic migraine according to the 3rd edition of the international classification of headache disorder (ichd-iii); * at least 4 monthly migraine days; * good compliance to study procedures; * availability of headache diary at least of the preceding months before enrollment. exclusion criteria: * subjects with contraindications for use of gepants; * concomitant diagnosis of medical diseases and/or comorbidities that, in the investigator's opinion might interfere with study assessments; * medical comorbidities that could interfere with study results; * pregnancy and breastfeeding. * changes in preventive treatments in the month before the first administration of rimegepant

Keywords: headache medication overuse headache pain migraine prevention gepant rimegepant