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Rimegepant, sold as Nurtec ODT a medication used for the acute treatment of migraine with or without aura in adults. Globally, approximately 15% of people are affected by migraine. In the Global Burden of Disease Study, conducted in 2010, migraines ranked as the third-most prevalent disorder in the world. As of 2016, it is one of the most common causes of disability. An early description consistent with migraines is contained in the Ebers Papyrus, written around 1500 BCE in ancient Egypt. Word "migraine" is from the Greek ἡμικρᾱνίᾱ (hēmikrāníā), 'pain in half of the head', from ἡμι- (hēmi-), 'half' and κρᾱνίον (krāníon), 'skull'. Common triggers quoted are stress, hunger, and fatigue (these equally contribute to tension headaches). Psychological stress has been reported as a factor by 50 to 80% of people. Migraine has also been associated with post-traumatic stress disorder and abuse. Tyramine – which is naturally present in chocolate, alcoholic beverages, most cheeses, processed meats, and other foods – can trigger migraine symptoms One theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem. Adenosine is a neuro-modulator and may be involved with migraine. Released after the progressive cleavage of adenosine triphosphate(ATP)(cell fuel energy molecule), adenosine acts on adenosine receptors to put the body and brain in a low activity state by dilating blood vessels and slowing the heart rate, such as before and during the early stages of sleep. Adenosine levels have been found to be high during migraine attacks. Caffeine's role as an inhibitor of adenosine receptor antagonist may explain its effect in reducing migraine. Low levels of the neurotransmitter serotonin, also known as 5-hydroxytryptamine (5-HT), are also believed to be involved. Many of the side effects of common anti-migraine medications stem from the broad biological role of CGRP receptors & the protein peptide ligand that normally activates them. CGRP receptors are found throughout the body, suggesting that the protein may modulate a variety of physiological functions in all major systems (respiratory, endocrine, gastrointestinal, immune, and cardiovascular). In wounds, CGRP receptors found in nerve cells deactivate the immune system, to prevent collateral damage in case of a clean wound (common case). In very preliminary research, nerve blockers such as lidocaine or botox have been demonstrated to block CGRP cascade, thereby allowing immune system involvement and control of pathogens, resulting in complete control and recovery Calcitonin gene-related peptide (CGRP) receptor antagonists are a class of drugs that act as antagonists of the calcitonin gene-related peptide receptor (CGRPR). Several monoclonal antibodies that bind to the CGRP receptor or peptide have been approved for prevention of migraine. Three small molecule CGRPR antagonists are approved in the U.S. as antimigraine agents. Drugs of this class have also been investigated for use in osteoarthritis. Non-peptide small molecules Ubrogepant is approved for acute treatment of migraines Rimegepant (BMS-927711) is approved for acute and preventative treatment of migraines Atogepant (AGN-241689) is approved for preventative treatment of migraines Telcagepant (MK-0974), reached phase III clinical trials; development discontinued in 2011. Olcegepant (BIBN-4096BS) is a drug candidate BI 44370 TA (BI 44370) MK-3207 SB-268262 Zavegepant (BHV- 3500) is a nasal spray approved for acute treatment of migraines. Monoclonal antibodies targeting the CGRP receptor Erenumab (AMG-334) is approved for prevention of migraine. Monoclonal antibodies targeting the CGRP molecule
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