Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Metzger, Jay

Keywords

migraine disorders/drug therapy, double-blind method, calcitonin gene related peptide receptor antagonists/therapeutic use, 5-HT1F receptor agonists adult, oral administration, lasmiditan, rimegepant, safety, and triptan

Abstract

Migraine headaches are one of the most common causes of primary headaches. Worldwide, migraines are one of the leading causes of disability and while the mechanism of migraines are not entirely understood, they result in significant disability for those who experience them. Dihydroergotamine was introduced for migraine treatment in the 1920s and in the 1990s triptans were introduced and have been the mainstay of acute migraine treatment since their introduction. In recent years, there have been several developments in the acute treatment and prophylaxis of migraine headaches. Some of the more widely studied and recently developed interventions include calcitonin gene related peptide (CGRP) receptor antagonists and 5-HT1F receptor agonists. These have been researched, developed, and approved by the FDA for acute migraine treatment. The purpose of this literature review was to compare the efficacy and safety of rimegepant, a CGRP receptor antagonist and lasmiditan, a 5HT1F receptor antagonist in the treatment of acute migraine attacks. This comparison was accomplished by a thorough review of scientific articles available through various resources such as PubMed, Clinical Key and CINAHL Complete. The results from various clinic trials indicated that rimegepant and lasmiditan are both superior to placebo in aborting an acute migraine in addition to eliminating most bothersome associated symptoms. Rimegepant and lasmiditan were also proved to be safe in the tested populations although each pharmacological intervention does carry its own set of potential side effects. There have been no direct studies comparing both drugs or comparing the drugs to triptans, however several meta analyses showed triptans to still be superior in aborting acute migraine headaches.

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