Rimegepant and Atogepant: What These CGRP-Blocking Migraine Pills Can Do Now and What's Coming Next | Research

The takeaway

Rimegepant and atogepant are oral CGRP receptor antagonists (gepants) with clear current migraine indications and emerging potential for pediatric use, pregnancy, cluster headache, post-traumatic headache, and patients who discontinued CGRP antibodies.

42 studies synthesized
Review covers the current evidence base for rimegepant and atogepant across approved and emerging indications

What the researchers found

Rimegepant and atogepant demonstrate significant clinical innovation in migraine therapy with approved indications for acute and preventive treatment, while data is emerging for expanded roles in pediatric, pregnancy, cluster headache, and post-CGRP-antibody-discontinuation populations.

Why it matters

Gepants fill an important gap — they're the first oral preventive migraine medications that target the CGRP pathway, offering an alternative for patients who can't tolerate or don't want injectable CGRP antibodies. Understanding their full potential could benefit the millions of migraine sufferers with limited options.

The numbers in context

Rimegepant can be used acutely (as needed) or preventively (every other day). Atogepant is taken daily for prevention.

How the study worked

Database search for 'Rimegepant OR Atogepant' yielding 240 results, refined to 42 studies through relevance assessment for narrative review synthesis.

Who was studied

Clinical trial data across migraine patient populations

What this study cannot tell us

Review article — no new data generated. Data for expanded indications is limited or absent. The review notes that gepants remain underutilized, suggesting real-world adoption lags behind evidence. Long-term safety data for emerging populations (pediatric, pregnancy) is particularly sparse.

How to read the evidence

Moderate evidence as a narrative review synthesizing 42 studies, covering well-established approved indications with strong trial data, plus emerging areas with limited evidence.

When this study was published

Published in 2024, capturing the current state of the rapidly evolving gepant field as these relatively new drugs expand their clinical footprint.

The bigger picture

The gepant class represents a paradigm shift in migraine treatment — oral medications that can both treat acute attacks and prevent future ones by blocking CGRP. As data accumulates for expanded indications (children, pregnant women, other headache types), these drugs could transform care for populations that currently have very limited evidence-based options.

Questions still open

Are gepants safe and effective in children and adolescents with migraine?
Can rimegepant or atogepant serve as rescue therapy for patients who discontinue CGRP antibody treatment?
How do gepants compare to CGRP antibodies for migraine prevention in head-to-head trials?

Common questions

What's the difference between gepants and CGRP antibody injections for migraine?

Both block the CGRP pathway, but gepants are oral pills while CGRP antibodies (like Aimovig, Ajovy, Emgality) are monthly or quarterly injections. Gepants can be used for both acute attacks and prevention, while CGRP antibodies are prevention-only. Gepants are small molecules that block the CGRP receptor directly, while antibodies neutralize either the CGRP protein or its receptor. For patients who prefer pills over injections, or who need acute + preventive coverage from one drug, gepants may be preferable.

Can I switch to a gepant if a CGRP antibody injection didn't work for me?

This is an area of active research. The review notes it as a potential future indication, but data is currently limited. Some patients who discontinued CGRP antibodies may respond to gepants because they work slightly differently at the molecular level. However, more studies are needed before this becomes a standard recommendation. Discuss with your headache specialist.

Read the original research

Rimegepant and atogepant: novel drugs providing innovative opportunities in the management of migraine.

Expert review of neurotherapeutics, 24(11), 1107-1117

View on PubMed ↗Publisher’s paper ↗

Citation

Wells-Gatnik, William David; Pellesi, Lanfranco; Martelletti, Paolo. (2024). Rimegepant and atogepant: novel drugs providing innovative opportunities in the management of migraine.. Expert review of neurotherapeutics, 24(11), 1107-1117. https://doi.org/10.1080/14737175.2024.2401558