In a multicenter chart review of 71 pediatric patients, the CGRP receptor antagonists rimegepant and atogepant were generally well tolerated and provided some benefit for migraine prevention, even in youth who had failed multiple prior treatments.
58% saw benefit from rimegepantOver half of pediatric patients on rimegepant experienced at least some improvement in headache prevention, despite having already failed a median of six prior preventive treatments.
What the researchers found
Among 71 pediatric patients (55 on rimegepant, 26 on atogepant, 10 on both), 58% (32/55) of rimegepant users and 43% (11/26) of atogepant users experienced at least some benefit for headache prevention. This is notable because these were treatment-resistant patients who had already failed a median of 6-7 prior preventive medications.
Side effects were infrequent and mild: only 4 of 55 rimegepant patients and 7 of 26 atogepant patients reported any side effects, with no serious adverse events. An exploratory analysis found that patients with longer headache histories were more likely to benefit (OR 1.41, 95% CI: 1.07-1.85, p=0.014), while those with more severe functional limitations were less likely to respond (OR 0.18, 95% CI: 0.05-0.58, p=0.004).
Why it matters
Migraine is one of the most disabling conditions in children and teens, yet very few preventive treatments have been studied or approved for this age group. Gepants represent a new class of peptide-targeting drugs that have proven effective in adults, and this real-world evidence provides the first multicenter look at how they perform in youth — filling a critical gap while randomized trials are still underway.
How the study worked
This was a multicenter retrospective chart review conducted at three major pediatric centers: Children's Hospital of Philadelphia, Cincinnati Children's Hospital, and UCSF Benioff Children's Hospital. Researchers reviewed records of all patients under 18 who were prescribed rimegepant or atogepant for headache prevention. Clinical data before and after treatment were collected using REDCap, and descriptive statistics summarized the findings.
What this study cannot tell us
This was a retrospective chart review, not a randomized controlled trial, so there was no placebo comparison group and results may be influenced by selection bias and the placebo effect. The sample size was relatively small (71 patients), data collection at one site was a convenience sample, and the study was not designed to compare the two medications head-to-head. Follow-up periods and outcome measures were not standardized across sites.
How to read the evidence
This is a retrospective multicenter chart review — a type of observational study that provides real-world evidence but cannot establish causation. The lack of a control group, non-standardized outcomes, and relatively small sample size limit the strength of conclusions, though the multicenter design adds credibility.
When this study was published
Published in 2026, this is a very recent study reflecting current clinical practice with gepants in pediatric populations. It provides timely real-world evidence while randomized controlled trials are still in progress.
The bigger picture
CGRP-targeting therapies have revolutionized adult migraine treatment over the past decade, but their use in pediatric populations has lagged behind due to the lack of clinical trial data. This study adds to the momentum for studying gepants in children and teens, joining a broader effort to expand evidence-based migraine treatment options beyond the adult population. The results are encouraging enough to support the ongoing randomized controlled trials in this age group.
Questions still open
- Will the ongoing randomized controlled trials confirm the safety and efficacy signals seen in this real-world chart review?
- Why did patients with longer headache histories respond better — does prolonged CGRP-mediated sensitization make them more responsive to CGRP blockade?
- Are there long-term developmental or safety concerns with CGRP receptor blockade in growing children and adolescents?
Common questions
What are gepants and how do they prevent migraines?
Are gepants approved for use in children?
Read the original research
Gepants for headache prevention in children and adolescents: A multicenter chart review study.
Headache, 66(1), 239-248
Citation
Shin, Lauren; Mentz, Olivia; Gelfand, Amy A; de Prado, Blanca Marquez; Shapiro, Hannah; Oh, Ann; Onifade, Ogo-Oluwa; Saunders, Jessica; Raj, Nichelle; Szperka, Christina L. (2026). Gepants for headache prevention in children and adolescents: A multicenter chart review study.. Headache, 66(1), 239-248. https://doi.org/10.1111/head.15087