Preventive treatment · Oral CGRP
Oral CGRP medications: the breakthrough in pill form.
Qulipta and Nurtec — the same scientific advance that changed migraine prevention, available as a pill instead of an injection. Here’s what they are, who they’re for, and how Wellday gets you on them.
What they are
CGRP therapy without the needle.
Oral CGRP medications target the same biological pathway as the CGRP biologic injections — the chemical (CGRP) that triggers migraine cascades — but they come in pill form. They belong to a class called gepants, which block the CGRP receptor.
There are two oral CGRP medications currently FDA-approved for migraine prevention:
- Qulipta (atogepant) — taken daily, FDA-approved for migraine prevention only
- Nurtec ODT (rimegepant) — taken every other day for prevention, or as needed for acute treatment of an attack
Nurtec is unusual in that it’s the only medication FDA-approved for both preventing migraines and stopping them when they happen. That dual-use flexibility is one of its most valuable features — many patients reduce the total number of medications they need to manage by using Nurtec for both purposes.
How they work
Same pathway as the biologics, different delivery.
Migraine attacks are triggered in part by a chemical called CGRP — calcitonin gene-related peptide — that activates inflammation, vascular changes, and pain pathways during an attack. CGRP biologics (Aimovig, Ajovy, Emgality) target this pathway via injection. Qulipta and Nurtec target the same pathway in pill form.
How they work specifically:
They block the CGRP receptor.
Both medications are CGRP receptor antagonists. They block the receptor that CGRP plugs into — preventing the chemical from triggering the migraine cascade. The biologics either bind to CGRP itself or its receptor; the orals work specifically on the receptor.
The clinical effects are similar to the injectables.
Reduction in migraine frequency, often by 50% or more, within the first one to three months of treatment. The main differences come down to convenience, speed of onset, and patient preference.
Who qualifies
If you have 4 or more migraine days a month — and prefer a pill.
Qulipta and Nurtec are FDA-approved for adults with episodic migraine (4–14 days per month). Nurtec is also approved for acute treatment of any migraine. They’re particularly good fits for:
Good candidates
- Patients who want CGRP-class effectiveness without the injection
- Patients newly starting CGRP therapy who want to test response before potentially moving to injectables
- Patients who travel frequently and prefer not to manage refrigerated injection medication
- Patients who want a single medication (Nurtec) for both prevention and rescue
- Patients with cardiovascular concerns that rule out triptans — the orals have a clean cardiovascular profile
May not be the right fit
- Patients who prefer the simplicity of a monthly injection to a daily or every-other-day pill
- Patients with severe liver impairment — your clinician will review this
- Patients who are pregnant or planning to become pregnant — safety data is still developing
The Wellday assessment is designed to identify the best CGRP option for your specific situation. Many patients are eligible for both biologics and orals — and the choice often comes down to lifestyle preference rather than clinical superiority.
What to expect
What treatment actually feels like.
Qulipta is a once-daily pill, taken at any time of day, with or without food. The dose is individualized — typically starting at 60mg, sometimes higher for chronic migraine patients. Most patients begin seeing reduction in migraine frequency within the first month, with full effect by month three.
Nurtec ODT is an orally disintegrating tablet — it dissolves on your tongue, no water needed. For prevention, it’s taken every other day. For acute treatment, it’s taken at the onset of a migraine. Many patients use it preventively most weeks but also have it available for breakthrough attacks. The flexibility is part of why it’s become so popular.
Timeline for results. Most patients see meaningful reduction in migraine days within 2–4 weeks. By month three, you and your clinician will have a clear picture of how well it’s working.
What “responding” looks like. The clinical benchmark is at least a 50% reduction in monthly migraine days. A patient who had 10 migraine days per month before treatment and 4–5 afterward is a typical responder.
If the first one doesn’t work. Some patients respond better to one CGRP medication than another. Switching from Qulipta to Nurtec, from oral CGRP to a biologic, or vice versa is often productive. Wellday handles those transitions as part of standard care.
Side effects
Generally well-tolerated.
Like the CGRP biologics, the oral CGRPs are notably well-tolerated compared to older preventive medications. The most commonly reported side effects:
What you won’t typically experience: cognitive fog, weight gain, sexual side effects, mood changes. The tolerability problems that drove patients off topiramate, amitriptyline, and propranolol largely don’t happen with oral CGRP medications.
One important note: Both Qulipta and Nurtec are processed by the liver. If you take other medications that interact with the same liver enzymes — certain antifungals, some antibiotics, some antidepressants — your clinician will review interactions carefully. Most patients have no issue.
Pregnancy and breastfeeding: Safety data is still developing. If you’re trying to conceive, pregnant, or breastfeeding, your clinician will discuss timing carefully.
How Wellday handles it
We do the hard parts. You start treatment.
Oral CGRP medications are highly effective. Like the biologics, they’re also expensive without insurance — Qulipta runs around $1,000 per month at list price, Nurtec around $850 — and almost every commercial insurance plan requires prior authorization.
This is the gap where most patients give up.
We submit the prior authorization.
Our clinical partners submit PA requests using documentation pre-populated from your intake. Most PAs are approved within 1–2 weeks.
We handle step therapy if your insurer requires it.
Many plans require you to have tried older oral preventives (topiramate, amitriptyline, propranolol) before approving CGRP. If you've tried them and they failed or you couldn't tolerate them, we document that properly. If you haven't, we walk you through which older preventive makes the most clinical sense to try first — and we move quickly to switch you to CGRP once the requirement is satisfied.
We file appeals if denied.
Most denials are overturned with proper documentation. Wellday's clinical team submits appeals as part of standard care.
We coordinate the manufacturer savings card.
Both Qulipta and Nurtec have copay assistance programs through their manufacturers. For most commercially insured patients, the savings card brings out-of-pocket cost to $0–5 per month. Wellday enrolls you automatically.
We handle annual renewals.
Your PA needs to be renewed every year. We do that for you, in the background, so your treatment never lapses.
Wellday Care is $69/month for the Prevention path. That’s the platform fee. The medication itself is typically $0–5 per month after insurance and savings card coordination.
Common questions
Questions we hear all the time.
Is Qulipta or Nurtec better?
Different medications, different best-fit patients. Qulipta is once-daily and FDA-approved for prevention only. Nurtec is every-other-day for prevention and can also be taken acutely to stop an attack — flexibility most other medications don't offer. Neither is clinically superior; the choice depends on your preference and pattern. Wellday's clinician helps you decide.
Should I try an oral CGRP or a biologic first?
Both are reasonable starting points. The orals offer faster onset and easier discontinuation if needed; the biologics offer the simplicity of a monthly injection and don't require remembering daily dosing. Many patients start with an oral and transition to a biologic if they want the convenience — or vice versa. There's no wrong choice between them.
Can I take Nurtec and a triptan?
Generally yes, but not at the same time for the same attack. Some clinicians recommend alternating — using a triptan for some attacks and Nurtec for others — to avoid relying too heavily on either. Your clinician will guide you based on your pattern.
Can I drink alcohol while on Qulipta or Nurtec?
There's no specific contraindication with alcohol. That said, alcohol is a known migraine trigger for many patients, so the question is more about whether drinking is helpful for your migraine patterns generally — not about the medication.
How long do I need to take it?
There's no fixed timeline. Many patients stay on oral CGRP medication indefinitely because it continues to work. Some gradually taper off after a year or two of stable improvement, with their clinician's guidance.
What if my insurance won't cover it?
If commercial insurance denies after appeal, we'll discuss cash-pay options. The manufacturer savings card typically brings cash-pay cost to around $69–99/month depending on the medication. If you're on Medicare, Medicaid, Tricare, or VA, the savings card programs don't apply, and we'll be honest about whether Wellday can help in your situation.
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From the founder
“I suffered through migraines for two decades before I got real treatment. Wellday is what I wish I’d had — and we’re building it to be seamless and accessible to everyone like me.”
— Jeff Glasco, Founder
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The information on these pages is for general education about migraine and its treatments. It is not medical advice and is not a substitute for evaluation, diagnosis, or treatment by a licensed clinician. Wellday’s care plans are developed individually for each patient based on clinical history, current medications, and personal situation. Always consult with a clinician before starting, stopping, or changing any medication. If you are experiencing a medical emergency or sudden severe headache with new neurological symptoms, call 911 or go to the nearest emergency room.