A US survey of adults already taking rimegepant found that female participants reported different reasons and migraine triggers for using it as short-term prevention (STP) than male participants. Female participants more often cited a doctor's recommendation, migraine frequency and migraine severity. They also more often reported stress, disrupted sleep, noise, light, dehydration and hormonal changes as migraine triggers, while male participants more often reported sexual activity. The survey found high satisfaction across the schedules people reported, but it did not test whether rimegepant was effective for preventing migraine.
Why participants chose short-term prevention
A doctor's recommendation was the most common reason overall, reported by 94 people, or 61.8% of the STP group. It was reported by 69.4% of female participants and 48.1% of male participants. Female participants also more often cited migraine frequency, 43.9% versus 25.9%, and migraine severity, 43.9% versus 22.2%. The corresponding p values were 0.014, 0.036 and 0.008. The analysis used 0.05 as a two-tailed cutoff, but the tests were nominal and unadjusted, and the study was exploratory.
The reported triggers also diverged
Stress, disruptive sleeping patterns and noise were among the most common reported factors in both groups. Stress was reported by 74.5% of female participants and 59.3% of male participants; disruptive sleeping patterns by 53.1% and 35.2%; and noise by 48.0% and 35.2%. Female participants also more often reported hormonal changes, 29.6% versus 7.4%, light, 48.0% versus 27.8%, and dehydration, 39.8% versus 22.2%. Period or menstrual cycle was reported by 30.9% of female participants. Male participants more often reported sexual activity, 14.8% versus 3.1%.
How participants used rimegepant
Nearly two-thirds of the STP group, 64.5% or 98 participants, said they used rimegepant after experiencing a migraine to prevent additional attacks. The survey reported no significant sex difference in the situations in which it was used. Most STP users learned about this use from a prescribing physician: 134 participants, or 88.2%, including 90.8% of female and 83.3% of male participants.
The reported schedules varied. Some 36.2% of participants, or 55 people, took rimegepant one time; 37.5%, or 57 people, took it every day; and 42.1%, or 64 people, took it every other day. Approximately half used it for two to three days, and the study reported no sex difference in frequency.
Satisfaction was high, but efficacy was not tested
Among respondents, satisfaction was 80.0% for one-time use, 77.2% for everyday use and 76.6% for every-other-day use. For one-time use, satisfaction was 94.4% among male participants and 73.0% among female participants. That difference had p = 0.08 and was not statistically significant under the study's 0.05 threshold. Satisfaction is not the same as an objective reduction in migraine days, and the survey did not capture changes in weekly or monthly migraine days.
The researchers analyzed self-reported real-world use in a two-phase, cross-sectional online survey of US residents aged 18 or older with episodic or chronic migraine. Participants had started rimegepant at least three months earlier and had taken at least one dose in the previous 30 days. The eligibility rules also excluded people taking more than one prescription preventive, those who had participated in a previous rimegepant trial and people using another gepant at the same time.
Of 25,077 people screened, 425 adults with migraine were enrolled, and none discontinued. The results identified three mutually exclusive rimegepant-use groups: STP users, long-term-prevention-only users and acute-only users. The STP group contained 152 participants, including 98 female and 54 male participants. The acute-only group contained 190 participants.
Because this was a cross-sectional observational survey, it can show patterns in reported use but cannot establish that biological sex caused the differences. The analysis was exploratory and hypothesis-generating. Small sample sizes prevented robust multivariable or sensitivity analyses, and only 15.8% of participants used rimegepant for STP only. The study therefore did not establish rimegepant efficacy for STP or support off-label use, and satisfaction cannot be used as evidence that the treatment reduced migraine frequency.
Paper data and sources
Original title: Sex differences in the real-world use of rimegepant for short-term prevention of migraine in the United States
Authors: Monteith T, Cirillo J, Nakajima K et al.
Journal/Repository: Frontiers in neurology
Status: Peer-reviewed
First online: 2026-10-09
DOI: Not available
Original paper · Full text