Does Rimegepant (Nurtec ODT) Work Every Time? What a 377-Attack Study Found
In 191 people who logged 377 migraine attacks, rimegepant (Nurtec ODT) gave pain freedom at 2 hours in 45% of attacks. For most people, the response changed from one attack to the next.
On this page · 11 sections
Why This Study Was Done
Rimegepant (Nurtec ODT) is a gepant, an acute migraine medication that blocks the CGRP receptor. It is taken as a 75 mg tablet that dissolves on the tongue. Its approval was based on large placebo-controlled trials, and those trials mostly measured how well it worked on a single migraine attack.
That leaves out a question many people ask after their first dose: will it work the same way next time? Someone whose first attack responds well may be disappointed by the second, and someone whose first attack did not respond may stop the drug too early.
A study published on October 27, 2026 in Cephalalgia followed people in Italy as they treated up to four separate migraine attacks with rimegepant and recorded how each one went. It gives some of the first attack-by-attack data on this drug outside a clinical trial.
How the Study Was Done
This was a prospective study carried out at several Italian headache centers. It is real-world evidence, meaning patients were prescribed rimegepant as part of their usual care rather than being randomly assigned to it, and there was no placebo group.
Each participant could treat up to four migraine attacks with rimegepant 75 mg. They used an electronic diary to rate their pain every 30 minutes, from the start of the attack until 2 hours after the dose.
The participants had lived with migraine for an average of about 28 years. Not everyone treated four attacks. All 191 treated a first attack, 110 treated a second, 46 treated a third, and 30 treated a fourth.
Main outcome: pain freedom at 2 hours, meaning no head pain at all 2 hours after taking the tablet, counted across every treated attack.
Consistency: the share of people who treated at least two attacks and were pain-free at 2 hours in at least two of them.
Safety: any side effects reported during the study.
What the Study Found
Across all attacks, rimegepant led to complete pain freedom at 2 hours a little under half the time. The 95% confidence interval ran from 39.3% to 49.6%.
The consistency results show more variation. Of the 110 people who treated at least two attacks, about a third were pain-free in two or more of them. The authors also reported that about one in five participants was pain-free at 2 hours after every attack they treated.
Who Was More Likely to Be Pain-Free
The researchers accounted for age, how soon rimegepant was taken, how bad the pain was at the time of the dose, current preventive treatment, and how many preventive drug classes had failed in the past. After that adjustment, three factors were linked to pain freedom.
OR stands for odds ratio. An odds ratio of 3.2 means the odds of being pain-free at 2 hours were a little over three times higher in that group.
People who were already using a CGRP monoclonal antibody for prevention, such as erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), or eptinezumab (Vyepti), were less likely to be pain-free after rimegepant than people who were not.
This does not mean the antibody stops rimegepant from working. People who need an antibody often have harder-to-treat migraine, and both drugs act on the same CGRP pathway, so there may be less left for the gepant to block. The study was not designed to tell these explanations apart.
The Results at a Glance
| Measure | Result | What it means |
|---|---|---|
| 2-hour pain freedom, all attacks | 44.6% (168 of 377) | Rimegepant (Nurtec ODT) fully stopped the pain within 2 hours in a little under half of attacks |
| Attacks treated per person | 191 first, 110 second, 46 third, 30 fourth | Fewer people stayed in the study for later attacks, so results for attacks three and four rest on smaller numbers |
| Pain-free in at least two attacks | 36.4% of those who treated two or more | A response in one attack does not guarantee a response in the next |
| Pain-free in every treated attack | About 1 in 5 participants | A smaller group responded every time |
| Side effects | 11.5% of participants | Similar to what was seen in earlier trials, with no new safety signals |
How This Compares With the Clinical Trials
In the phase 3 trial that led to approval of the dissolving tablet, 21% of people taking rimegepant were pain-free at 2 hours, compared with 11% on placebo. The 44.6% in this new study is much higher.
The two numbers should not be compared directly. In the new study, everyone knew they were taking rimegepant, and there was no placebo group, which tends to push response rates up. Our post on placebo response in migraine trials explains how much expectation and the natural course of an attack add to results. Real-world patients may also treat earlier in the attack or have different migraine patterns from trial participants.
For more on how rimegepant compares with other options, see our overview of gepants for migraine and the analysis of over-the-counter painkillers versus gepants and lasmiditan.
Common Questions This Study Helps Answer
Will rimegepant work every time I take it?
Probably not. In this study, a minority of people were pain-free after every attack they treated. Most people had a mix of attacks that responded fully and attacks that did not. A response that varies from one attack to the next is normal for acute migraine medications in general, not a sign that something is wrong.
It did not work on my first attack. Should I stop taking it?
One attack is not enough to judge. Attacks differ in severity, timing, and triggers, and this study shows how much the response can change from one attack to the next. The American Headache Society suggests trying an acute treatment on more than one attack before deciding whether it works, and discussing the results with your clinician. Writing down each attack in a migraine tracker journal makes that conversation easier.
Can I take it if I already use a CGRP antibody for prevention?
Some people in this study were doing exactly that, and the study found no new safety concerns overall. The combination was less likely to bring full pain freedom than rimegepant alone in people not on an antibody. If you use both and rimegepant often falls short, tell your clinician, since there are other acute options to consider.
Does having frequent migraine days make it less effective?
In this study, the odds of pain freedom fell slightly with each additional monthly migraine day. If your attacks are frequent, the chronic migraine calculator can help you see where you fall, and you may want to ask your clinician about preventive treatment.
How often can I take it?
The labeled limit for acute use is one 75 mg dose in 24 hours. Frequent use of any acute medication can lead to medication overuse headache, though gepants appear to carry less of this risk than some older drugs. The medication overuse headache checker can help you review your monthly use.
Limitations to Keep in Mind
- No placebo group. Without a comparison group, the study cannot show how much of the 44.6% response came from rimegepant itself.
- People dropped off over time. Only 30 people treated a fourth attack. Those who stayed in the study may differ from those who stopped, for example because the drug was working for them.
- One country. All centers were in Italy, and patients came from specialist headache clinics, where migraine tends to be more severe.
- Associations, not causes. The links with sex, antibody use, and migraine frequency are observed patterns. They do not prove that these factors change how rimegepant works.
What This Means for People With Migraine
- Expect some variation. Rimegepant (Nurtec ODT) brought full pain freedom within 2 hours in a little under half of attacks, and results changed from one attack to the next for most people.
- Give it a fair trial. Judge it across several attacks rather than one. Note how long each attack lasted and whether you needed a second medication.
- Share the details. If you also use a CGRP antibody, or your migraine days are frequent, mention this when reviewing your acute treatment. The migraine appointment summary sheet has space for this.
- Prevention is a separate question. Rimegepant is also approved for preventing episodic migraine when taken every other day. Our post on rimegepant for prevention covers that use.
Key Takeaways
- In 191 people who treated 377 migraine attacks, rimegepant (Nurtec ODT) gave pain freedom at 2 hours in 44.6% of attacks.
- Of the people who treated two or more attacks, 36.4% were pain-free in at least two, and about one in five participants was pain-free every time.
- People not on a CGRP antibody, women, and people with fewer monthly migraine days were more likely to be pain-free.
- 11.5% of participants reported a side effect, and no new safety concerns appeared.
- There was no placebo group, so these results are higher than, and not directly comparable with, the original clinical trials.
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Talk with a qualified healthcare provider before starting, stopping, or combining migraine medications.
References
- Vaghi G, Ornello R, Sebastianelli G, et al. Effectiveness of rimegepant across multiple acute migraine attacks: A real-world, prospective, multicentric study. Cephalalgia. Published online October 27, 2026. doi:10.1177/03331024261484897.
- Croop R, Goadsby PJ, Stock DA, et al. Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial. The Lancet. 2019;394(10200):737-745. doi:10.1016/S0140-6736(19)31606-X.
- Ailani J, Burch RC, Robbins MS. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153.
CGRP
Atogepant and Weight: What a One-Year Study Found
In a one-year study of nearly 600 people on atogepant, average weight went down.
Women's health
CGRP Migraine Drugs and Women's Health: Periods, Pregnancy, Breastfeeding, and Birth Control
A review of 16 studies on CGRP drugs during periods, pregnancy, breastfeeding and birth control.
CGRP
