Zomig vs. Nurtec

See how Zomig and Nurtec compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Zomig is a triptan that narrows blood vessels to stop a migraine already in progress, while Nurtec blocks CGRP and can both treat an attack and prevent future ones.

  • Zomig is contraindicated in people with heart disease or stroke history because of its vasoconstrictive action, a restriction Nurtec does not carry.

  • Nurtec's side effect rates in trials were much lower than Zomig's, but it has no generic option and typically costs more each month.

Zomig vs. Nurtec Drug Summary

Zomig

Zomig (zolmitriptan) is a triptan that treats acute migraine attacks by narrowing blood vessels and calming overactive pain signals. It comes as a tablet, an orally disintegrating tablet, or a nasal spray, taken at the first sign of a migraine and repeated after two hours if the headache returns.

Nurtec

Nurtec (rimegepant) is a CGRP receptor antagonist that treats migraine attacks and can also prevent episodic migraine using the same orally disintegrating tablet. It dissolves on the tongue and is taken as needed for an attack or every other day for prevention.

Zomig vs. Nurtec Side Effects

Zomig

Most common
asthenia (up to 14%)
nausea (up to 12%)

Nurtec

Most common
nausea (up to 2.7%)
abdominal pain/dyspepsia (up to 2.4%)

Zomig vs. Nurtec Dosage

Zomig

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1.25 mg or 2.5 mg At the start
Maximum dose 5 mg as single dose If needed
Dose changes 2 increases As tolerated

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

Zomig vs. Nurtec Indications

Zomig

Zomig is approved for the acute treatment of migraine with or without aura in adults. It is meant to stop a migraine that has already started, not to prevent future attacks.

  • Treats acute migraine attacks with or without aura

  • Available as a tablet, orally disintegrating tablet, or nasal spray

  • Approved for adults only; tablet and ODT not approved under age 12

  • Not approved for migraine prevention or cluster headache

Nurtec

Nurtec is approved for the acute treatment of migraine with or without aura and for preventing episodic migraine in adults. The same orally disintegrating tablet is used for both purposes, just on different schedules.

  • Treats acute migraine attacks with or without aura

  • Also approved to prevent episodic migraine in adults

  • Same ODT formulation used for both acute and preventive dosing

  • Not approved for chronic migraine prevention or cluster headache

Zomig vs. Nurtec Pros and Cons

Zomig

Zomig has decades of real-world use and comes in three forms, which helps patients who have trouble swallowing pills during an attack or who have nausea. Because it works by narrowing blood vessels, it is not an option for people with heart disease or a history of stroke.

Pros

  • Available as tablet, ODT, or nasal spray for faster options during an attack

  • Long track record of use since FDA approval in 1997

  • Generic tablet form can cost far less than Nurtec, roughly $13 to $1,332 a month depending on formulation and coverage

  • Nasal spray option works well for people with migraine-related nausea or vomiting

Cons

  • Contraindicated in people with coronary artery disease or history of stroke

  • Higher rates of dizziness, paresthesia, and asthenia in trials than Nurtec

  • Not approved to prevent migraines, only to stop an active attack

  • Short half-life may mean a second dose is needed for some attacks

Nurtec

Nurtec's mechanism does not constrict blood vessels, so it avoids the cardiovascular restrictions that limit triptans like Zomig. It is the only oral CGRP option approved for both stopping an active migraine and preventing future ones with a single formulation.

Pros

  • Not contraindicated for people with heart disease or stroke history

  • Can be used both to treat an attack and to prevent episodic migraine

  • Notably lower rates of nausea and other side effects in clinical trials

  • Dissolves on the tongue without water, useful during an attack

Cons

  • No generic version available, typically $1,000 to $1,376 a month without insurance

  • Risk of hypersensitivity reactions, including anaphylaxis, sometimes days after a dose

  • Must avoid strong CYP3A4 inhibitors, which limits use with certain other medications

  • Not approved for chronic migraine prevention

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