Efficacy and safety of rimegepant in Chinese women with pure menstrual migraine: a retrospective observational study

To evaluate rimegepant’s effectiveness and safety in the short-term prevention of pure menstrual migraine. Rimegepant’s effectiveness and safety in both acute and preventive treatment of migraine have been demonstrated by numerous studies. However, no evidence is available for its effect on menstrual migraine, especially pure menstrual migraine. We conducted an observational and retrospective study to investigate whether rimegepant could serve as an effective short-term preventive treatment for pure menstrual migraine. This was a retrospective study. Data of patients diagnosed with pure menstrual migraine was selected from the Headache Outpatient Center in the Second Affiliated Hospital of Soochow University. All these patients received 75 mg of rimegepant orally disintegrating tablets every other day during the perimenstrual period (from − 2 to + 3 days of menstruation) of three consecutive menstrual cycles. The change in attack duration from baseline was the primary endpoint. Secondary endpoints included reduction of peri-menstrual headache day (PHD), severity, Migraine Disability Assessment (MIDAS) scores, Headache Impact Test-6 (HIT-6) scores, Hamilton Anxiety Scale-14 (HAMA-14) scores, Hamilton Depression Scale (HAMD-17) scores, and Pittsburgh Sleep Quality Index (PSQI) scores. Change in the percentage of patients using acute migraine medications from baseline, proportion of patients with a ≥ 50% and ≥ 75% decrease from baseline in PHD were also analyzed as efficacy endpoints. Adverse events (AEs) were collected to evaluate the tolerability. We analyzed data from 43 patients with a mean age of 37.0 years. After three cycles of perimenstrual short-term preventive treatment with rimegepant, patients’ attack duration was decreased by 20.5 h from baseline (p < 0.001). The population experienced a 6-point reduction in headache severity (p < 0.001) and a 1.1-day improvement in PHD (p < 0.001) compared to baseline. Patients’ quality of life improved, with a 11.4-point improvement in HIT-6 scores (p < 0.001) and a 10.1-point improvement in MIDAS scores (p < 0.001). No significant improvement was observed in indicators of anxiety (p = 0.788), depression (p = 0.745), or sleep quality (p = 0.903) compared to baseline. Only 2 patients reported mild adverse events. Our study demonstrated that 3-cycles perimenstrual prophylactic treatment of rimegepant was associated with reductions in migraine attack duration, perimenstrual attack frequency, severity, as well as improved patients’ life quality. Rimegepant might be an effective way for patients with pure menstrual migraine.