Nurtec vs Ubrelvy for Migraine

Nurtec vs Ubrelvy: how these two migraine medicines compare

If you've been offered Nurtec or Ubrelvy for your migraine attacks, you're looking at two of the most talked-about medicines in headache care right now. Both are gepants — a newer class of oral medicine that blocks CGRP, a protein your brain releases during an attack. Both are FDA-approved to treat migraine once it starts. The biggest practical difference is that Nurtec also carries an approval for preventing attacks, while Ubrelvy is built strictly for acute treatment.

Neither one is automatically the "better" choice. A headache specialist can help you match the medicine to your pattern of attacks, your other prescriptions, and what your insurance will actually cover.

Key takeaways

• Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant) are both gepants — oral medicines that block the CGRP receptor to stop a migraine attack.
• Nurtec is FDA-approved for both acute treatment and prevention of episodic migraine. Ubrelvy is FDA-approved for acute treatment only.
• Nurtec is an orally dissolving tablet that needs no water. Ubrelvy is a standard tablet you swallow.
• Ubrelvy allows a second dose two or more hours after the first. Nurtec does not.
• No trial has pitted the two drugs directly against each other. A 2024 network meta-analysis placed both behind several triptans on pain relief, though still ahead of placebo — useful context, but not a head-to-head verdict.⁶
• Neither drug narrows blood vessels the way triptans do, which is why both are options for people who can't take triptans for cardiovascular reasons. Newer prescribing information for Nurtec does flag postmarketing reports of new or worsening hypertension and Raynaud's phenomenon, so this isn't a completely risk-free swap.³

What is a gepant, and how do Nurtec and Ubrelvy work?

During a migraine attack, levels of a protein called calcitonin gene-related peptide (CGRP) rise sharply. CGRP widens blood vessels and switches on pain pathways in and around the brain, which is a big part of why an attack brings throbbing pain, nausea, and light sensitivity all at once.²

Gepants were built specifically to sit on the CGRP receptor — the docking site where CGRP attaches and sets that cascade in motion — and block it.¹ Because they work downstream of blood vessel narrowing rather than through it, they sidestep a limitation that rules triptans out for some people.

Nurtec ODT contains rimegepant. Ubrelvy contains ubrogepant. Both target the same receptor. Where they part ways is formulation, FDA approvals, and dosing rules.

What is Nurtec ODT, and what is it approved for?

Nurtec ODT (rimegepant 75 mg) is an orally disintegrating tablet — you place it on or under your tongue and it dissolves without water. It was first approved by the FDA in 2020 for acute migraine treatment, and in 2021 it became the first oral gepant, and the first migraine medicine of any kind, approved for both acute and preventive treatment in adults.¹

For acute treatment, the dose is one 75 mg tablet as needed, with a maximum of one dose in 24 hours and no more than 18 doses in a 30-day period. For prevention, the dose is one 75 mg tablet every other day.³

In the pivotal acute treatment trial, 21.2% of people taking Nurtec were pain-free at two hours, compared with 10.9% on placebo, and pain relief was reported by 59.3% on Nurtec versus 43.3% on placebo.² For prevention, Nurtec reduced monthly migraine days by roughly one day more than placebo at 12 weeks, a modest but statistically real difference.²

Nurtec is generally well tolerated, and nausea is the most commonly reported side effect. Its current FDA label also carries a few warnings worth knowing about, not just for Nurtec but for CGRP-blocking drugs as a class: serious allergic reactions (sometimes appearing days after a dose), new or worsening high blood pressure, and new or worsening Raynaud's phenomenon have all been reported after the drug reached the market.³ None of these are common, but they're the reason your clinician will still want to know your full history even though gepants avoid the vasoconstriction risk tied to triptans.

What is Ubrelvy, and what is it approved for?

Ubrelvy (ubrogepant) is a standard oral tablet swallowed with water. It reached the market in December 2019 as the first oral gepant approved for acute migraine treatment in adults, and it has never been approved for prevention.¹

It comes in 50 mg and 100 mg doses. Unlike Nurtec, a second dose is allowed at least two hours after the first, up to a maximum of 200 mg in 24 hours.⁴

Across its pivotal ACHIEVE trials, roughly 19-21% of people on Ubrelvy were pain-free at two hours, compared with about 12-14% on placebo.⁷ A more recent development is worth knowing about if you tend to feel a migraine coming before the headache itself starts: a 2023 phase 3 trial published in The Lancet found that taking Ubrelvy during the prodrome — the early warning symptoms that show up before head pain — reduced how often a moderate or severe headache went on to develop, in people who could reliably recognize that early stage.⁵

The most common side effects of Ubrelvy are nausea, drowsiness, and dry mouth.⁴

How do Nurtec and Ubrelvy compare side by side?

The table below pulls together the key differences. The efficacy figures come from each drug's own trials, not a shared study, so treat them as a general picture rather than a scoreboard.

Efficacy data from separate trials — not head-to-head. See references for source studies.

What does "no head-to-head trial" actually mean for you?

No study has ever put Nurtec and Ubrelvy side by side in the same trial at the same time. Each drug's efficacy numbers come from its own separate placebo-controlled trial, and while those numbers look broadly similar, the trial populations, designs, and placebo response rates all differed enough that you can't line the percentages up and call a winner.

The closest thing we have is a 2024 network meta-analysis in The BMJ, which statistically combined dozens of trials across triptans, NSAIDs, and newer drugs including rimegepant and ubrogepant.⁶ It found that several triptans (eletriptan, rizatriptan, sumatriptan, and zolmitriptan) outperformed both rimegepant and ubrogepant for pain relief, though rimegepant and ubrogepant still beat placebo. That's a meaningful data point, but it's an indirect statistical comparison, not a real head-to-head trial, and it says nothing about how either gepant will perform for you specifically — especially if you're one of the many people who can't take a triptan in the first place.

Which one might be right for you?

The decision belongs to you and your clinician. That said, here are some of the questions that often point toward one or the other.

Nurtec ODT may be worth discussing if:

• You want one medicine that can both stop attacks and help prevent them
• Nausea makes swallowing a pill hard during an attack — the dissolving form may be easier
• You prefer a simpler every-other-day preventive schedule without a daily pill
• You have already tried preventive treatments that did not work

Ubrelvy may be worth discussing if:

• You only need acute treatment and have a separate preventive medicine in place
• Having the option of a second dose gives you more flexibility for stubborn attacks
• You can identify early prodrome symptoms and want to treat before full head pain starts⁵
• Your insurance covers it more favorably

What about triptans — how do gepants fit in?

Triptans were the standard of care for acute migraine treatment for decades, and plenty of people still do very well on them. Gepants aren't meant to replace triptans across the board — they're an alternative for people who:

• Can't take triptans because of cardiovascular disease or uncontrolled high blood pressure (triptans narrow blood vessels; gepants do not)
• Haven't gotten enough relief from triptans
• Want to avoid the vasoconstriction risk that comes with triptans
• Allergic reactions like hives after taking triptans

A 2026 clinical review in Headache summarized gepants' key advantages as favorable tolerability, no cardiovascular contraindications, and no link to medication overuse headache (sometimes called rebound headache), which can develop with frequent use of triptans or over-the-counter pain relievers.⁷ The same review noted that head-to-head studies between gepants and triptans still don't exist, so a lot of the "which is better" question comes down to your own history rather than a clean trial result.

What about cost and insurance?

Both Nurtec and Ubrelvy are brand-name prescription medicines with no generic available. Without insurance, either one can run $800 or more a month.⁸ Coverage and prior authorization requirements vary a lot by plan, and manufacturer savings programs can bring the price down significantly for people who qualify.

Talk with your clinician or a pharmacist about your specific formulary before starting either one. When efficacy looks similar and both drugs are medically reasonable for you, coverage can genuinely be the thing that decides it.

The right medicine is the one that works for your life

Nurtec and Ubrelvy are both meaningful options for people with migraine who want a targeted, well-tolerated acute treatment. The science behind them changed how migraine gets treated, and more people now have access to medicines that actually match the underlying biology of the disease rather than working around it.

Getting to the right choice takes a real conversation, not a comparison chart alone. At Haven Headache & Migraine Center, we look at the full picture: your attack pattern, your other medications, your insurance, and what you're actually trying to get back in your life. We can help you find an approach that fits, and adjust it as your needs change.

Medically reviewed by: Alicia Chang, MSN, APRN, FNP-BC, FNP-C, CEN, PHN, Haven Headache & Migraine Center and peer reviewed by Karissa Secora, DMSc, PA-C, AQH, Haven Headache & Migraine Center

Frequently asked questions

Can I take Nurtec and Ubrelvy at the same time?

No. Both block the same CGRP receptor, and the current FDA labeling for CGRP-blocking drugs like Nurtec advises against combining it with another gepant such as Ubrelvy.³ If you're using Nurtec for prevention and need a separate acute medicine, ask your clinician about an option with a different mechanism, such as a triptan.

Can gepants cause rebound headache?

Based on current evidence, gepants don't appear to cause medication overuse headache the way triptans and over-the-counter pain relievers can.⁷ That said, any acute medicine should be used at the recommended frequency and isn't a substitute for getting the underlying disease properly treated.

Are Nurtec and Ubrelvy safe if I have heart disease?

Gepants don't narrow blood vessels, which is the main cardiovascular concern with triptans, and neither drug was linked to cardiovascular toxicity in its clinical trials.⁷ That said, Nurtec's current label does note postmarketing reports of new or worsening high blood pressure, so this isn't a blanket "no cardiovascular risk at all" situation.³ If you have cardiovascular disease, talk with your clinician, who will weigh your full history.

Which gepant is better — Nurtec or Ubrelvy?

Neither is universally better. They haven't been tested head-to-head, and the closest indirect comparison found both performed similarly to each other but behind several triptans.⁶ Nurtec has the added advantage of a preventive indication and a dissolving tablet form. Ubrelvy offers the flexibility of a second dose. The best choice depends on your specific situation, other medications, and insurance coverage.

Can I take Nurtec or Ubrelvy if I am pregnant or breastfeeding?

Data on gepant use in pregnancy are still limited. Pregnancy registries exist for both medicines, and both current FDA labels include pregnancy safety information you and your clinician should review together before starting either drug while pregnant or breastfeeding.³⁴

Do gepants work if triptans have not?

They can. Rimegepant (Nurtec) has shown meaningful response rates even in people whose prior triptan treatment didn't work well for them.² Gepants work through a completely different mechanism than triptans, so not responding to a triptan doesn't mean a gepant won't help.

Can I take a gepant with my preventive migraine medicine?

It depends. If your preventive is a CGRP monoclonal antibody (like Aimovig, Ajovy, or Emgality), your clinician may steer you away from combining it with a gepant, since both act on the same CGRP pathway. If your preventive works through a different mechanism, such as a beta blocker or topiramate, a gepant for acute attacks is generally fine to use alongside it. Always check with your clinician first.¹

References

1. Jakubowska M, Sowa-Kućma M. Gepants: targeting the CGRP pathway for migraine relief. Frontiers in Pharmacology. 2025;16:1708226. https://doi.org/10.3389/fphar.2025.1708226
2. Blair HA. Rimegepant: A Review in the Acute Treatment and Preventive Treatment of Migraine. CNS Drugs. 2023;37(7):661-673. https://pmc.ncbi.nlm.nih.gov/articles/PMC10299922/
3. FDA. Nurtec ODT (rimegepant) Prescribing Information. 2026 revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/212728s029lbl.pdf
4. FDA. Ubrelvy (ubrogepant) Prescribing Information. 2025 revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211765s013lbl.pdf
5. Dodick DW, Goadsby PJ, Schwedt TJ, et al. Ubrogepant for the treatment of migraine attacks during the prodrome: a phase 3, multicentre, randomised, double-blind, placebo-controlled, crossover trial in the USA. The Lancet. 2023;402(10419):2307-2316. https://doi.org/10.1016/S0140-6736(23)01683-5
6. Karlsson WK, Ostinelli EG, Zhuang ZA, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis. BMJ. 2024;386:e080107. https://doi.org/10.1136/bmj-2024-080107
7. Lipton RB, et al. Integrating gepants into clinical practice for the acute treatment of migraine. Headache: The Journal of Head and Face Pain. 2026. https://doi.org/10.1111/head.70047
8. Medical News Today. Nurtec ODT: Side effects, use for migraine, cost, and more. Updated January 2024. https://www.medicalnewstoday.com/articles/drugs-nurtec-odt

Living with headache or migraine? The specialists at Haven Headache & Migraine Center are here to help. Book a virtual consultation.

This article is for general education and is not medical advice. It is not a substitute for care from a qualified health professional. Always talk with your clinician before starting, stopping, or changing any treatment. If you have a sudden, severe headache, the worst headache of your life, or a headache with new symptoms like weakness, trouble speaking, or vision loss, seek emergency care right away.