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

Most common
Nausea (up to 2.7%)
Abdominal pain/dyspepsia (up to 2.4%)
Urinary tract infection (up to 1.5%)
Dry mouth (up to 0.7%)

Emgality

Most common
Injection site reactions (up to 18%)
Injection site pain (10.1% to 11.6%)
Constipation (1.0% to 1.5%)
Vertigo (0.7% to 1.2%)

Nurtec vs. Emgality Dosage

Nurtec

Dosage
Dosage Table
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

Dosage
Dosage Table
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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