Acute treatment · Gepants
Gepants: a newer way to stop migraines.
Nurtec and Ubrelvy — fast-acting acute medications that target the CGRP pathway. No vasoconstriction, no triptan-style chest tightness, and a kinder side-effect profile. Here’s what they are and how Wellday handles them.
What they are
The acute treatment built on CGRP science.
Gepants are a class of acute migraine medications that came to market starting in late 2019. They target the same biological pathway as the CGRP biologics and oral preventive CGRP medications — the chemical (CGRP) that triggers migraine cascades — but they’re designed to be taken at the moment a migraine starts, not daily for prevention.
There are two gepants currently FDA-approved for acute migraine treatment in the United States:
- Ubrelvy (ubrogepant) — taken at the start of a migraine attack
- Nurtec ODT (rimegepant) — taken at the start of a migraine attack, and also FDA-approved for prevention every other day
Nurtec is the only medication in the United States approved for both acute and preventive use — a flexibility that’s reshaped how clinicians approach treatment plans.
A third gepant, Zavzpret (zavegepant), is a nasal spray version of the same class — useful for patients whose migraines come with severe nausea that makes pills hard to keep down.
How they work
Blocking the migraine signal — without constricting blood vessels.
When a migraine attack begins, the chemical CGRP — calcitonin gene-related peptide — surges and binds to its receptors, triggering the inflammation, vascular changes, and pain pathways that produce the migraine experience.
Gepants block CGRP receptors specifically. By preventing CGRP from attaching to its receptor, they interrupt the cascade before it reaches full intensity.
The clinical advantage over older acute medications
No vasoconstriction.
Unlike triptans, gepants don't narrow blood vessels. That makes them safer for patients with cardiovascular concerns and eliminates the chest-tightness and jaw-tightness sensations that some patients experience with triptans.
Cleaner side-effect profile.
Most patients tolerate gepants very well. The "migraine hangover" feeling that can follow triptan use is significantly less common.
Effective at multiple points in the attack.
While triptans work best when taken at the very first sign of migraine, gepants retain effectiveness even when taken later in the attack. This is meaningful for patients who don't always recognize the warning signs early.
Who qualifies
For most adults with migraine — particularly those triptans aren’t right for.
Gepants are FDA-approved for the acute treatment of migraine in adults. They’re a particularly good fit for:
Good candidates
- Patients with cardiovascular concerns that rule out triptans (history of heart attack, stroke, uncontrolled hypertension, peripheral vascular disease)
- Patients who experience strong vasoconstrictive side effects from triptans (chest tightness, jaw tightness, tingling)
- Patients who haven't responded well to multiple triptans
- Patients on antidepressants who want a cleaner interaction profile
- Patients who want a single medication for both acute and preventive use (Nurtec)
May not be the right fit
- Patients who respond well to triptans and prefer the lower cost (gepants are typically more expensive without insurance, though savings cards close the gap dramatically)
- Patients who can't tolerate even mild nausea
- Pregnant patients — safety data is still developing
The Wellday assessment identifies which acute medication is the best fit for your specific situation. Many patients are good candidates for both triptans and gepants — and the choice often comes down to personal experience and tolerability.
What to expect
What treatment actually feels like.
Taking a gepant. Both Ubrelvy and Nurtec are taken orally at the onset of a migraine. Nurtec ODT dissolves on your tongue without water — useful when you’re already feeling nauseated. Ubrelvy is a standard tablet swallowed with water. Zavzpret is a nasal spray.
The timeline. Pain relief typically begins within 1–2 hours. About half of patients report meaningful relief within 2 hours of taking a gepant. For patients whose migraines escalate slowly enough to give them time, gepants are often equally effective as triptans. For patients with rapidly escalating migraines, a triptan might still be the faster choice.
The dual-use option (Nurtec). Nurtec can also be taken every other day for prevention — meaning a single medication can serve both purposes for some patients. This is valuable for patients who want to simplify their medication routine or who want to test CGRP-class effectiveness before potentially moving to a daily preventive (Qulipta) or monthly biologic (Aimovig, Ajovy, Emgality).
What “responding” looks like
- Recognize the migraine starting
- Take the gepant
- Continue with your day
- Within 1–2 hours, the migraine de-escalates rather than progressing
- Minimal "post-migraine" fatigue
That experience — combined with the absence of vasoconstrictive side effects — is why gepants have become first-choice acute treatment for many clinicians, particularly for patients who couldn’t tolerate triptans.
Side effects
Generally well-tolerated.
Gepants have a notably clean side-effect profile compared to triptans. The most commonly reported side effects:
What you typically won’t experience: chest tightness, jaw tightness, tingling, the migraine-hangover feeling. The vasoconstrictive sensations that drive some patients off triptans are absent with gepants.
Important interactions
Both Ubrelvy and Nurtec are processed by the liver and can interact with certain other medications — particularly some antifungals, antibiotics, and HIV medications. Most patients have no issue, but your Wellday clinician will review your medication list carefully.
Medication overuse: Like all acute migraine medications, gepants can contribute to medication overuse headache if taken more than 10 days per month. If you find yourself reaching for acute medication that often, it’s a strong signal that you need a preventive medication added to your plan.
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
Prescribed quickly. Delivered. Insurance navigated.
Gepants are highly effective acute medications. They’re also expensive without insurance — list prices run around $850 per month for Nurtec and similar for Ubrelvy — and most commercial insurance plans require prior authorization or step therapy through generic triptans before approving them.
This is the gap where most patients give up.
We screen for fit.
During your intake and video consultation, we determine whether a gepant is the right acute medication for you, or whether a triptan is better aligned with your situation.
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.
Some plans require a documented failure or contraindication of generic triptans before approving a gepant. If you've tried triptans and they didn't work or you couldn't tolerate them, we document that properly. If you haven't, your clinician will discuss whether trying one first makes clinical sense — or whether a contraindication justifies skipping the step.
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 Nurtec and Ubrelvy have copay assistance programs. For most commercially insured patients, the savings card brings out-of-pocket cost to $0–5 per month. Wellday enrolls you automatically.
We adjust if it's not working.
If your gepant isn't producing the relief you need, we switch — to a different gepant, to a triptan, or to a different acute strategy entirely. Part of standard care.
Wellday Care is $19/month for the Relief path. For patients also on a preventive (recommended for anyone with 4+ migraine days per month), the Prevention path is $69/month. The medication itself is typically $0–5 per month after insurance and savings card coordination.
Common questions
Questions we hear all the time.
How are gepants different from triptans?
Both are acute migraine medications, taken when an attack starts. Triptans constrict blood vessels and target serotonin receptors. Gepants block CGRP receptors and don't affect blood vessels. Gepants tend to have a cleaner side-effect profile but typically cost more. For patients who can take both, the choice often comes down to personal experience.
Can I take Nurtec every day?
Nurtec is FDA-approved as an acute medication (taken when needed) and as a preventive medication (taken every other day). Daily use is not standard. If you're taking Nurtec acutely on more than 10 days per month, that's a strong signal you need to add a preventive medication, not increase Nurtec frequency.
Should I take a gepant or a triptan?
It depends on your medical history, side-effect tolerance, prior treatment response, and insurance situation. Both are excellent acute treatments. Wellday's clinician evaluates your situation and recommends the best fit — and switches if needed.
Can I take a gepant if I'm on a CGRP biologic?
Yes. Many patients use a CGRP biologic preventively (Aimovig, Ajovy, Emgality) and a gepant acutely for breakthrough migraines. Targeting the same pathway from two angles is clinically reasonable and commonly done.
Why is Nurtec more expensive than triptans?
Triptans are generic — most have been off-patent for over a decade, so prices have dropped dramatically. Nurtec and Ubrelvy are still under patent, and brand-name CGRP-targeted medications carry premium pricing. The manufacturer savings cards close most of the gap for commercially insured patients.
Are gepants safe long-term?
Long-term safety data is still accumulating since these medications have only been on the market since 2019. Current data is reassuring, but your clinician will discuss what's known and what's still being studied.
Related treatments
Keep exploring your options.
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
Read Jeff’s full story →Start today
Real migraine care, this week.
Tell us about your migraines. We handle everything else.
Build your free profile →Educational information
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.