To evaluate sex-based differences in gepant response for acute and preventive headache treatment in a tertiary care setting.

Real-world data regarding treatment response based on sex remains limited.

Of 3545 survey invites, 478 responses were completed (13.5%, age 49.9±14.5 years, 413 (86.4%) females, and 429 (89.7%) Caucasian). Patient preference between rimegepant and ubrogepant did not differ between sexes for acute use (n=166, p=0.502). Similarly, no preference difference was seen for preventive rimegepant and atogepant (n=31, p=0.191). For acute treatment responses, male and female rimegepant users reported similar consistency (out of 100%) across all measures (2-hour pain reduction: 75.5±21.3 vs. 72.5±20.9 and resumption of activity in 2 hours: 77.0±18.8 vs. 70.6±22.0). Similar results were seen in male and female ubrogepant users (2-hour pain reduction: 62.5±25.0 vs. 69.2±23.7; resumption of activity in 2 hours: 66.2±22.7 vs. 67.1±24.9). For preventive treatment, similar responses were seen in both sexes for moderate (<50%) or significant (≥50%) reduction in monthly headache days between both rimegepant (male 80% (4/5) vs female 73.9% (17/23)) and atogepant (male 80% (8/10) vs female 75.4% (49/65)). No differences between sexes were observed for other measures, including average headache intensity, daily function affected, and rescue medication usage days. 

Gepant acute (rimegepant vs ubrogepant) and preventive (rimegepant vs atogepant) responses appear similar between sexes according to this real-world survey at a tertiary headache center. Further research is needed to understand the sex-based differences in gepant use response.