Nurtec vs. Emgality
See how Nurtec and Emgality compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Nurtec is an oral tablet that treats a migraine attack as it happens and also prevents future episodic migraines, while Emgality is a once-monthly injection used only for prevention and for episodic cluster headache.
Emgality's most common side effect is injection site reactions, affecting up to 18% of patients, while Nurtec's most common side effects are nausea and abdominal discomfort, each under 3%.
Emgality typically costs less per month than Nurtec, but Nurtec avoids needles and covers both acute and preventive treatment in one medication.
Nurtec vs. Emgality Drug Summary
Nurtec
Nurtec (rimegepant) is a CGRP receptor antagonist used both to stop a migraine attack once it starts and to prevent episodic migraines before they occur. It comes as an orally disintegrating tablet taken as needed for an attack or every other day for prevention.
Emgality
Emgality (galcanezumab) is a CGRP monoclonal antibody used to prevent migraine and to reduce attacks of episodic cluster headache. It is given as a self-administered injection once a month, with an extra loading dose during the first month.
Nurtec vs. Emgality Side Effects
Nurtec
Emgality
Nurtec vs. Emgality Dosage
Nurtec
Emgality
| STAGE | DOSE | WHEN |
| Starting dose | 75 mg as needed | At the start |
| Maximum dose | 75 mg every other day | If needed |
| Dose changes | 1 increase | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 240 mg | Day 1 |
| Maximum dose | 300 mg once monthly | If needed |
| Dose changes | 2 increases | As tolerated |
Nurtec
| STAGE | DOSE | WHEN |
| Starting dose | 75 mg as needed | At the start |
| Maximum dose | 75 mg every other day | If needed |
| Dose changes | 1 increase | As tolerated |
Emgality
| STAGE | DOSE | WHEN |
| Starting dose | 240 mg | Day 1 |
| Maximum dose | 300 mg once monthly | If needed |
| Dose changes | 2 increases | As tolerated |
Nurtec vs. Emgality Indications
Nurtec
Nurtec is FDA-approved for two distinct uses: stopping a migraine attack once it starts and preventing episodic migraines before they occur. It uses the same 75 mg tablet for both purposes, so patients don't need to keep two different medications on hand.
Acute treatment of migraine attacks
Preventive treatment of episodic migraine
Same tablet used for both acute and preventive dosing
Not approved for chronic migraine prevention
Not approved for cluster headache
Emgality
Emgality is FDA-approved to prevent migraine in adults and to treat episodic cluster headache, a rare but severe headache condition. It is not used to treat a migraine attack that has already started, only for prevention or cluster headache episodes.
Preventive treatment of migraine in adults
Treatment of episodic cluster headache
Not approved for acute migraine treatment
Not approved for use in patients under 18
Given as a self-injection at home
Nurtec vs. Emgality Pros and Cons
Nurtec
Nurtec is taken as needed for a migraine attack or every other day for prevention, giving patients flexibility from a single oral medication. It has one of the more favorable side effect profiles among CGRP therapies, though it carries a higher list price and no generic alternative exists.
Pros
Oral tablet, no injections needed
Treats attacks and prevents future migraines with one drug
Dissolves on the tongue without water
Lower rate of the most common side effects (under 3%)
Cons
No generic version available
Typically costs more than Emgality, roughly $1,000 to $1,376 a month without insurance
Not approved for cluster headache
Requires deciding between as-needed and every-other-day dosing
Emgality
Emgality is injected once a month, which some patients prefer over a daily or per-attack pill, and it is the only CGRP antibody approved for episodic cluster headache. Injection site reactions are common, but its lower list price makes it more accessible for patients without full insurance coverage for CGRP therapies.
Pros
Only needs to be injected once a month
Only CGRP therapy approved for episodic cluster headache
Typically costs less than Nurtec, roughly $650 to $900 a month without insurance
Established safety record since 2018 approval, no boxed warning
Cons
Requires self-injection with a pen or syringe
Injection site reactions occur in up to 18% of patients
Not approved for treating an active migraine attack
Needs a loading dose before reaching maintenance dosing
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