• J Headache Pain · Aug 2024

    Letter

    Situational prevention in migraine: are we doing the right thing?

    • Lanfranco Pellesi and Paolo Martelletti.
    • Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark. lpellesi@health.sdu.dk.
    • J Headache Pain. 2024 Aug 22; 25 (1): 137137.

    AbstractThis commentary addresses the use of rimegepant for situational prevention in migraine management. While the approach of using prophylactic treatments during high-risk periods is not new, its application with rimegepant described by Lipton et al. raises ethical and clinical concerns. These include the challenge of defining high-risk periods, the potential for overmedication, and the risk of medication overuse headache (MOH). The current evidence on MOH with gepants is inconclusive, and recommendations on dosing may be insufficient. Additionally, the long-term safety of calcitonin gene-related peptide (CGRP) antagonists remains uncertain, especially regarding cardiovascular and other systemic effects. The commentary emphasizes the need for caution and thorough investigation into the long-term risks and benefits of situational prevention with rimegepant before widespread adoption.© 2024. The Author(s).

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