Migraine attacks when a triptan cannot be used or did not work, online

Common symptoms

• Throbbing or pulsating pain, often on one side
• Attacks that last from about 4 hours up to 3 days if untreated
• Nausea or vomiting with attacks
• Light or sound sensitivity, wanting a dark, quiet room
• A visual or tingling aura that fades within an hour before the headache

May fit online care

• Adults 18 and older
• You are 18 to 64
• A clinician already diagnosed your migraine
• Your attacks match your usual pattern
• You cannot take a triptan because of a heart or blood vessel problem
• Or you cannot take a triptan for another warning on its label
• Or two triptans did not help enough
• Or a triptan gave you side effects you could not stand
• You can check your blood pressure once a day for 7 days after your first tablet
• You have none of the warning signs below

Look for another care setting

• If more than one of these fits, follow the first one.
• A sudden 'thunderclap' headache that reaches maximum intensity within about a minute, or the worst headache of your life. Call 911 or go to the ER now.
• Headache with fever, stiff neck, a new rash, or confusion. Call 911 or go to the ER now.
• Any new weakness, numbness, trouble speaking, vision loss, double vision, clumsiness, or unusual drowsiness, even if it fades. Do not assume it is your aura. Call 911 or go to the ER now.
• Brief blackouts of vision. Call 911 or go to the ER now.
• Headache with a painful red eye or a drooping eyelid. Call 911 or go to the ER now.
• Chest pain or pressure, or pain that spreads from your chest to your arm, shoulder, neck, jaw, or back. Call 911 or go to the ER now.
• Trouble breathing, or fainting. Call 911 or go to the ER now.
• A face that droops on one side. Call 911 or go to the ER now.
• Signs of a severe allergic reaction: swelling of the lips, face, mouth, tongue, or throat, difficulty breathing, or widespread hives. Call 911 or go to the ER now.
• You took more than 1 tablet in 24 hours, even if you feel fine. Call 911 or go to the ER now.
• A fast and irregular heartbeat, especially if you also have other symptoms, or a racing, pounding, skipped or uneven heartbeat with sweating or dizziness. Call 911 or go to the ER now.
• A seizure for the first time, or a seizure with your headache (happening now or recently). Call 911 or go to the ER now.
• A severe or sudden headache during pregnancy or soon after childbirth, especially with vision changes, swelling, or upper belly pain. Call 911 or go to the ER now.
• Headache after a significant head or neck injury, especially with vomiting, confusion, drowsiness, passing out, or a blood thinner. Call 911 or go to the ER now.
• Do not drive yourself. Do not wait for our reply.
• A first-ever severe headache, or a headache different from your usual migraine pattern. Go to the ER or urgent care today.
• A new headache that started at age 50 or older. Go to the ER or urgent care today.
• Headaches that are steadily getting worse over weeks or months. Go to the ER or urgent care today.
• Headache triggered by coughing, straining, exertion, or sex, or that clearly changes with position. Go to the ER or urgent care today.
• A new whooshing or pulsing sound in the ears. Go to the ER or urgent care today.
• Headache that began after a head or neck injury. Go to the ER or urgent care today.
• New or worsening headache during pregnancy or after recent childbirth. Go to the ER or urgent care today.
• A history of cancer, HIV, organ transplant, chemotherapy, or a weakened immune system. Go to the ER or urgent care today.
• You take a blood thinner (warfarin, Eliquis, Xarelto, or similar). Go to the ER or urgent care today.
• Hemiplegic or basilar (brainstem-aura) migraine: aura with one-sided weakness, trouble speaking, vertigo, or double vision. Go to the ER or urgent care today.
• 15 or more headache days a month, or headache medicine on more than 10 days a month. Go to the ER or urgent care today.
• Your most recent blood pressure reading was 180/110 or higher, no matter how long ago you took it. Go to the ER or urgent care today.
• Chest pain or pressure in the last 4 weeks that was new, came more often, came at rest, or got worse. Go to the ER or urgent care today.
• New neck pain with this headache, or neck pain that is not part of your usual attacks. Go to the ER or urgent care today.
• New or different heart palpitations, which means a racing, pounding, skipping, or uneven heartbeat. Go to the ER or urgent care today.
• Your fingers or toes turn white, blue, numb, cold, or painful after a tablet. See a doctor in person today.
• A new rash after a tablet, or hives that are not widespread. See a doctor in person today.
• You are under 18. See a doctor in person today.
• You are pregnant, might be pregnant, or plan to become pregnant. The label has no good data on pregnancy. See your pregnancy doctor.
• Before you start the tablets, see your own doctor if any of these is true.
• You are 65 or older.
• A clinician never formally diagnosed your migraine, or you are not sure.
• Your attacks do not match the usual migraine features.
• You can take a triptan, you have not tried two triptans, and no triptan gave you side effects you could not stand.
• You had a heart attack, a stroke or TIA, a stent, bypass surgery, or other heart surgery in the last 6 months. See your own doctor.
• You have coronary artery spasm. See your own doctor.
• You have poor blood flow to the bowel (ischemic bowel or ischemic colitis). See your own doctor.
• You have small vessel disease, or narrowed arteries inside the brain. See your own doctor.
• You have Raynaud's phenomenon, which means fingers or toes that turn white, blue, or numb in the cold. See your own doctor.
• You have a racing, pounding, skipping, or uneven heartbeat that no clinician is caring for. See your own doctor.
• You have signs of heart failure that are new or getting worse: swollen feet or ankles, quick weight gain, or shortness of breath when you lie down or that wakes you from sleep. See your own doctor.
• Your last blood pressure reading from the last 3 months was 140/90 or higher. See your own doctor.
• You have no blood pressure reading from the last 3 months. A pharmacy machine, a home cuff, or a clinic reading all count. See your own doctor.
• You cannot check your blood pressure once a day for 7 days after your first tablet, with a home cuff or a pharmacy machine. See your own doctor.
• After you start, a blood pressure reading of 140/90 or higher. See your own doctor.
• You have cirrhosis or severe liver disease. See your own doctor.
• You have kidney failure that needs dialysis, or end-stage kidney disease. See your own doctor.
• You ever had any allergic reaction, even a mild one, to rimegepant, Nurtec ODT, any ingredient in the tablet, ubrogepant, atogepant, or zavegepant. The tablet also has benzyl alcohol, eucalyptol, gelatin, limonene, mannitol, menthol, menthone, menthyl acetate, sucralose, and vanillin. See your own doctor.
• You are not sure if you have ever reacted to the tablet or to any ingredient in it. See your own doctor.
• You are breastfeeding. The label has no data on the effect on a breastfed baby. See your own doctor.
• Before you start the tablets, see your own doctor if you take or drink any of these. Some medicines change how this tablet works.
• You take itraconazole, ketoconazole, clarithromycin, or Paxlovid (nirmatrelvir with ritonavir).
• You take rifampin, phenytoin, a barbiturate, or St. John's wort.
• You take fluconazole, verapamil, diltiazem, cyclosporine, ciprofloxacin, fluvoxamine, or grapefruit juice.
• You take amiodarone, dronedarone, quinidine, lapatinib, or ranolazine.
• Take no more Nurtec ODT (rimegepant) tablets until a doctor says it is safe.