Dr. Ahmed
Nurtec (Rimegepant) is a medication classified as a CGRP antagonist, which stands for calcitonin gene-related peptide.
Migraines are thought to be caused by the widening of blood vessels in the brain, involving multiple mechanisms, including the activation of CGRP.
By inhibiting CGRP, drugs like Nurtec may theoretically increase the risk of brain ischemia and stroke.
There have been occasional reports of ischemic strokes occurring after the use of CGRP inhibitors.
For example, a 41-year-old woman experienced a thalamic stroke shortly after taking her first dose of Erenumab, another CGRP inhibitor, to treat her migraine with aura [Ref].
Nurtec is one of the most popular CGRP antagonists. It is available as an oral disintegrating tablet (ODT) and has been approved for both the acute treatment of migraines and their prevention.
Its popularity stems from its effectiveness in stopping migraines before they start or reducing their severity.
While many people find Nurtec helpful, there is a potential link between its use and an increased risk of stroke.
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What is Nurtec?
Nurtec is more known by its generic name Rimegepant and is prescribed by doctors to prevent occasional migraine headaches in adults.
As we mentioned above this drug targets the calcitonin gene-related peptide which is a small protein that helps cells in the nervous system communicate.
The increase in CGRP levels is thought to cause migraine symptoms like headache, nausea, sensitivity to light and sound, and vision issues.
Mechanism of action of Nurtec:
CGRP behaves as a chemical messenger in the brain. The increased levels of CGRP bind to specific receptors on nerve cells which triggers a cascade of events that cause migraine pain, inflammation, and blood vessel dilation.
The CGRP receptor antagonists (Nurtec) work by fitting into the CGRP receptor sites which will block the actual CGRP from binding.
As these receptors are not activated, Nurtec disturbs the pathway that leads to migraine pain and linked symptoms.
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Nurtec FDA approval for migraine prevention
Nurtec was first approved by the US Food and Drug Administration (FDA) on 27th February 2020 for the acute treatment of migraine.
However, its use in treating episodic migraines was approved in May of 2021 [ref]. It is available as an orally disintegrating tablet (ODT).
Understanding Stroke Risk
This is a medical emergency where the oxygen supply to the brain is interrupted. The brain needs a constant supply of nutrients and oxygen delivered from the bloodstream.
Once this supply is disturbed the brain cells start dying which could cause potential brain damage and long-term issues.
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Types of strokes:
Ischemic stroke:
This type is affecting nearly 87% [ref] of all stroke patients. Ischemic stroke occurs when a blood clot blocks an artery supplying blood to the brain.
This clot could be because of fatty deposits in the arteries (atherosclerosis) or a clot traveling from another part of the body.
Hemorrhagic stroke:
This occurs when a weakened blood vessel in the brain bursts which leads to bleeding and tissue damage. High blood pressure is another risk factor for hemorrhagic stroke.
General risk factors for stroke:
Other risk factors could lead to a stroke experience. Here are some of the most common ones.
- Age is a significant risk factor for stroke occurrence as people over 55 years are at an increased risk.
- Both ischemic and hemorrhagic strokes could be caused by uncontrolled high blood pressure.
- High LDL cholesterol levels can lead to plaque buildup in arteries which eventually causes ischemic stroke.
- T2DM can damage blood vessels and increase the risk of blood clots, again causing stroke.
- Smoking is a risk factor for every other disease and the same is the stroke case.
- A stroke family history can raise your chances of a stroke episode [ref].
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The Link Between Nurtec and Stroke Risk
Although the exact way Nurtec works is still being studied, there are a few ideas about how it might be linked to a higher risk of stroke, even though it targets CGRP receptors to prevent migraines:
Blood vessel effects:
The calcitonin gene-related peptide is a complex molecule with many roles. Besides its role in treating migraines, it also helps control blood vessels.
Some scientists think that blocking CGRP receptors with Nurtec might affect how blood vessels work [ref].
This could increase the chance of blood clots forming or blood vessels narrowing, which might lead to a stroke.
CGRP usually causes blood vessels to widen, but Nurtec blocks CGRP receptors, and some experts believe this might cause blood vessels to narrow instead.
This narrowing could limit blood flow to the brain, raising the risk of an ischemic stroke.
Lack of data:
Nurtec is a newer medication compared to other migraine treatments so, most studies on it have not tracked patients for long periods.
We do not fully understand the long-term effects of blocking CGRP receptors on stroke risk. Also, if there is an increased risk it might only show up with long-term use.
Strokes can take years to develop, so studies that follow patients for a longer time are important for a clear analysis.
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The bottom line:
It is important to remember that this link between stroke and Nurtec is only a supposed idea. No published research points out the link between this drug and stroke risk.
Talking to a healthcare professional is important before you start taking the medicine for your migraines.
You can figure out how Nurtec might affect the migraine treatment if you already have risk factors for stroke.
