Migraine - treating
RAG rating
Document type
NICE technology appraisal
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing


Rimegepant for treating migraine

NICE Technology Appraisal 919 recommends rimegepant as an option for the acute treatment of migraine with or without aura in adults, only if for previous migraines:

  • at least 2 triptans were tried and they did not work well enough or
  • triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.

Before rimegepant is considered the prescriber should confirm that (where applicable):

  • patient is keeping a headache diary (an example can be found here)
  • triptans have been taken early in the headache phase
  • the correct route of administration has been considered, e.g. use of nasal or subcutaneous injections of triptans in patients with early profuse vomiting
  • combination treatment with triptans and simple painkillers/anti-sickness medication has been considered

Initial trial should involve the issue of 4 tablets with a review appointment scheduled to assess tolerability and response before further prescriptions are issued.

A patient information leaflet & support resources are being developed and will be made available on this website when approved.