Yes, Nurtec (rimegepant) is FDA-approved as a preventive treatment for episodic migraine. It’s one of the few migraine medications with a dual approval, meaning it can be used both to stop a migraine once it starts and to reduce how often migraines occur in the first place. The preventive dose is 75 mg taken every other day, compared to the as-needed dose of 75 mg when a migraine hits.
How Prevention Dosing Works
When used for prevention, you take one 75 mg dissolving tablet every other day on a consistent schedule, regardless of whether you feel a migraine coming on. This is different from the acute use, where you take the same 75 mg tablet only when a migraine strikes (up to once per day). The tablet dissolves on your tongue without water, which makes the every-other-day routine straightforward.
If you’re using Nurtec for prevention and still get a breakthrough migraine on an “off” day, you can take a tablet to treat that attack. The key rule is no more than one tablet in any 24-hour period.
How Well It Works for Prevention
In the main clinical trial published in The Lancet, people taking Nurtec every other day experienced about 4.3 fewer migraine days per month after 12 weeks, compared to 3.5 fewer days in the placebo group. That’s a real but modest advantage of roughly one additional migraine-free day per month over placebo. The benefit builds over time, so it takes several weeks of consistent use before the full effect becomes clear.
That gap may sound small, but it’s worth putting in context. Placebo responses in migraine prevention trials tend to be large, which compresses the difference between drug and placebo. For many people, the combination of fewer migraines plus the ability to use the same medication to treat breakthroughs makes Nurtec a practical option.
Side Effects During Preventive Use
Because you’re taking a tablet every other day rather than occasionally, side effects during preventive use matter more than with acute-only use. In clinical trials, the most common issues were nausea (about 2.7% of patients) and stomach pain or indigestion (about 2.4%). Both occurred at low rates, and most people tolerated the medication well.
A long-term safety study followed 1,800 adults using Nurtec for up to 52 weeks. The most frequently reported problems were everyday issues like upper respiratory infections and sinus infections, not effects tied to the drug itself. Only about 1.6% to 2% of participants stopped taking Nurtec because of side effects, and no serious adverse events were considered related to the medication. That’s a reassuring safety profile for something taken regularly over months or years.
Where It Fits Among Preventive Options
Nurtec belongs to a class of medications called gepants, which work by blocking a protein called CGRP that plays a central role in triggering migraines. The American Headache Society updated its position in 2024 to recommend CGRP-targeting therapies, including gepants, as a first-line option for migraine prevention. That puts Nurtec in the same tier as older preventives like certain blood pressure medications and antiseizure drugs, not as a last resort.
Compared to injectable CGRP antibodies (monthly or quarterly shots), Nurtec offers an oral alternative for people who prefer not to inject. Some patients use both: a CGRP antibody injection for baseline prevention and Nurtec as needed for breakthrough attacks. A small study found this combination was well tolerated over 12 weeks with minimal additional side effects.
Insurance Coverage Can Be Restrictive
Getting Nurtec covered for prevention often involves more hurdles than getting it approved for acute use. Many insurance plans and pharmacy benefit managers require prior authorization, and some enforce step therapy, meaning you need to show that older, cheaper preventives didn’t work before they’ll approve Nurtec.
As an example of how strict these requirements can get, the VA system requires documented failure of or intolerance to at least three traditional preventive medications (from categories like beta-blockers, antiseizure drugs, and certain antidepressants), plus failure of at least one injectable CGRP antibody, plus failure of another oral gepant before approving Nurtec for prevention. Private insurance criteria vary but often follow a similar philosophy of requiring you to try older, less expensive medications first. Your prescriber’s office typically handles the prior authorization paperwork, but the process can take days to weeks.
Episodic vs. Chronic Migraine
Nurtec’s preventive approval specifically covers episodic migraine, generally defined as 4 to 14 migraine days per month. If you experience 15 or more headache days per month (chronic migraine), Nurtec is not currently approved for prevention in that category, though it can still be prescribed off-label at your provider’s discretion. The clinical trial that supported approval enrolled people with episodic migraine, so the strongest evidence applies to that group.
For the acute treatment of individual attacks, however, there’s no distinction. Nurtec can be used to treat a migraine whether your overall pattern is episodic or chronic.