To evaluate the safety and efficacy of gepants for the acute treatment of migraine in pediatric patients.

Calcitonin gene-related peptide (CGRP) has been found to be elevated during migraine attacks. Gepants are oral CGRP receptor antagonists, which have been shown to be effective for acute and preventive treat of migraine in adults. Generally, they are well tolerated with limited side effects. Currently, they are FDA approved in adults for migraine, however, there is limited data on their use in pediatrics.

Retrospective chart review of patients < 18 years old who were prescribed a gepant (rimegepant or ubrogepant) for acute migraine treatment at a single institution from 1/1/2020 to 1/1/2023. Data was collected through chart review for all patients that used ≥ 1 dose of a gepant. Safety and tolerability were assessed through reported side effects, laboratory data and vital signs pre- and post-gepant use. The data was evaluated using descriptive statistics and compared using paired t-tests.

Thirteen patients were identified. Median (range) age was 16 years (13 to 17). There were 10 females and 3 males. Five (38%) had episodic migraine, 5 (38%) had chronic migraine and 3 (23%) had hemiplegic migraine. At baseline, median (range) headache days per month was 10 (0 to 30). Patients tried on median (range) 5 (1 to 8) acute medications before being prescribed a gepant. At the follow-up visit, 11 (85%) had reported any improvement or resolution of their migraine attack with use of a gepant. Zero patients reported side effects and there were no significant laboratory, height or weight changes seen after gepant use.

The results indicate that gepants may be an effective acute treatment for migraine in pediatric patients. They appear to be safe and well-tolerated. However, larger prospective and randomized trials need to be conducted to confirm these results.