Advanced International Journal for Research

E-ISSN: 3048-7641   •   Impact Factor: 9.11

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Volume 7 Issue 2
March-April 2026

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Emerging Role of Gepants in the treatment of Migraine in Emergency Department

Author(s) Dr. Ramit Singh Sambyal
Country India
Abstract Migraine is a common and disabling neurological disorder that frequently presents to the emergency department (ED), contributing to significant patient distress, prolonged length of stay, and recurrent healthcare utilization. Advances in migraine pathophysiology have identified calcitonin gene-related peptide (CGRP) as a key mediator in trigeminovascular activation, neurogenic inflammation, and pain transmission. Gepants, a novel class of small-molecule CGRP receptor antagonists, have emerged as effective agents for both acute and preventive management of migraine. This review summarizes current evidence regarding the pharmacological mechanisms, clinical efficacy, safety profile, and practical applicability of gepants, with a particular focus on their role in the emergency department setting. Second- and third-generation gepants, including ubrogepant, rimegepant, atogepant, and zavegepant, demonstrate meaningful pain relief within two hours, sustained symptom control, and favorable tolerability without vasoconstrictive effects. These properties make them especially relevant for patients with cardiovascular comorbidities, triptan intolerance, or contraindications to conventional migraine therapies. Clinical trials and real-world studies suggest comparable efficacy to established treatments, reduced need for rescue medication, and minimal hepatotoxicity. However, challenges such as cost, limited availability, lack of ED-specific trial data, and the need for greater clinician familiarity remain barriers to widespread adoption. Ongoing research, guideline integration, and targeted education are expected to further define the role of gepants in optimizing evidence-based, individualized migraine management in emergency care.
Keywords Clinical decision-making, Emergency care systems, Emergency medicine
Field Medical / Pharmacy
Published In Volume 7, Issue 2, March-April 2026
Published On 2026-03-30
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E-ISSN 3048-7641
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