Treating Acute Migraines With Ubrelvy

Medically Reviewed by Christina Bookwalter, PharmD, BCPS, BCACP, MS MEd on May 28, 2024
7 min read

The approval of medicines called CGRP antagonists has led to big changes in how migraine is managed. These medicines work in a different way than older medicines to treat or prevent migraine. The first CGRP antagonists were only available by injection, and they were only approved to prevent migraine. Ubrelvy (you-brel'-vee) was approved in 2019 as the first CGRP antagonist taken by mouth to treat acute migraine. 

Migraine is a condition where you have intense headaches, usually with throbbing pain on one side. The headache can come back again and again and may last for up to 72 hours. You may also have what is called an aura, where you have changes in your vision or other symptoms, such as numbness or trouble speaking.

The active ingredient in Ubrelvy is ubrogepant. You may also hear it called a “gepant.” It is a calcitonin gene-related peptide (CGRP) antagonist. CGRP is a protein that causes blood vessels to widen and can lead to pain and inflammation during a migraine. CGRP may also have a role in causing migraine. CGRP antagonists prevent CGRP from binding to its receptors and having its effects. Blocking CGRP can help relieve pain during a migraine attack. 

It comes as a 50-milligram and 100-milligram tablet that you take by mouth, with or without food, as needed for acute migraine. You may take a second dose at least 2 hours after the first dose if needed. But if you are taking certain medicines, or you have eaten grapefruit or drunk grapefruit juice, you should not take the second dose within 24 hours. For more details, see the section about interactions below.

You should also not take more than 200 milligrams of Ubrelvy in 24 hours. Your health care provider may prescribe a lower dose if you have kidney or liver problems. 

Two clinical studies were done to see if Ubrelvy was safe and effective for treating acute migraine compared to a placebo containing no medicine. People in the studies did not know if they were getting Ubrelvy or the placebo. Efficacy was measured by the percent of adults who were pain-free or free of their most bothersome migraine symptoms (such as nausea or sensitivity to light or sound) 2 hours after their dose.

In both studies, people were told to treat their migraine if they had moderate to severe pain. If the first dose did not work or they had a repeat migraine, they could take a second dose (either placebo, Ubrelvy, or their usual medicine for treating migraine) 2 to 48 hours after the first dose. 

Up to 23% of people in these studies were taking medicines to prevent migraine, but none were taking other medicines that affected CGRP. The studies included people who had a history of migraines for at least 1 year, had migraines usually lasting 4 to 72 hours, and had two to eight migraine attacks per month. About 89% of people treated with Ubrelvy in these studies were female, 82% were White, and the average age was 41.

A significantly higher percent of people in these studies who took Ubrelvy saw the benefits below compared to those who took the placebo. These benefits were seen with both the 50-milligram and 100-milligram doses.

  • Free of pain: Up to 21.8% of people who took Ubrelvy were pain free 2 hours after the dose, compared to up to 14.3% of people who took the placebo.
  • Free of the most bothersome migraine symptom (such as nausea or sensitivity to light or sound): Up to 38.9% of people who took Ubrelvy were free of their most bothersome symptom at 2 hours after the dose, compared to up to 27.8% of people who took the placebo.

The studies also looked at how many people continued to be free of pain 2 to 24 hours after their dose. Up to 15.4% of people taking Ubrelvy had no pain during this timeframe compared to up to 8.6% of people taking the placebo.

You should start to see relief of migraine pain or other bothersome symptoms (such as nausea or sensitivity to light or sound) within 2 hours of taking your dose. If you still have symptoms 2 hours after your dose, you can usually take another dose, as long as you aren’t taking any medicines that interact. For more details, see the section about interactions below.

Tell your health care provider if Ubrelvy does not reduce your headache pain after a second dose. Your health care provider may increase your dose, or they can discuss other options for treating acute migraine. Depending on how many migraines you have in a month, your health care provider may also discuss whether you should use a medicine to prevent migraines.

The most common side effects are nausea and sleepiness. 

Nausea is a common symptom that can happen with migraine in general. To limit nausea, you can try simple steps like eating bland foods, such as toast or crackers, and avoiding strong smells, such as from cooking, perfume, or smoke. Your health care provider may also prescribe medicine to help manage nausea if you commonly have nausea during a migraine.

Because Ubrelvy can cause sleepiness, do not drive or do other activities that require alertness or coordination until you know how it affects you.

These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

Ubrelvy is usually taken as needed to treat acute migraine. In studies, people could treat up to eight migraines per month with Ubrelvy. There are no studies to say whether it is safe to use it to treat more than eight migraines in 30 days. Consider keeping a headache diary to keep track of when you have migraines and when you take your migraine medicines. This can help you and your health care provider find out how well your medicines are working for you.

While not common, a severe allergic reaction may happen with Ubrelvy. Stop taking Ubrelvy and get help right away if you have symptoms of a serious allergic reaction, such as breathing problems, swelling of the face, lips, mouth, tongue, or throat, or a severe rash, itching, or hives. This type of reaction can occur minutes, hours, or days after taking Ubrelvy.

Several medicines can affect the blood levels of Ubrelvy. Your body has enzymes and proteins that process and remove many types of medicines from the body. Other medicines can affect this process, which may slow down or speed up how Ubrelvy is broken down or cleared from your body. 

For example, taking Ubrelvy with medicines that inhibit certain enzymes or proteins could increase the amount of Ubrelvy in your body. This may lead to excessive or dangerous side effects. Grapefruit juice can also inhibit some of these enzymes. 

 On the other hand, taking Ubrelvy with medicines that induce certain enzymes could decrease the amount of Ubrelvy in your body. This may cause it to work less well or not work at all. 

If you are taking certain medicines that inhibit or induce these enzymes or proteins, you may not be able to take Ubrelvy at all, you may need to take a lower dose, or in some cases, you should not take a second dose within 24 hours. Ask your pharmacist or other health care provider if any of your medicines interact with Ubrelvy. 

Tell your health care provider about all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken. Also tell them if you eat grapefruit or drink grapefruit juice. This will help them find out if there are any interactions with Ubrelvy or if you need a dosage adjustment. Do not start or stop other medicines while taking Ubrelvy without talking to your health care provider.

Ubrelvy requires a prescription from a health care provider. Your primary care provider, neurologist, or a headache specialist may prescribe Ubrelvy. You can get it at any pharmacy.

There is a savings card available from the manufacturer that may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance and what type of insurance you have. You can find out more at www.ubrelvy.com/savings or by texting UBRELVY to 48764.