What You Need to Know About the New Nasal Spray for Migraine

Laura Cinski, MD, is a specialty care physician board-certified in general neurology and headache medicine. She is the medical director of the Inova Headache Program.

Almost 40 million people in the United States have migraine. Worldwide, it’s the second leading cause of disability after low back pain among people of all ages, and the leading cause of disability for women ages 15 to 49. But most people with migraine don’t realize safe and effective prescription preventive treatments and acute medications are available. They aren’t limited to what’s available over the counter.

The newest migraine treatment is zavegepant, the first nasal spray offered for this type of acute medication. Acute (or rescue) medications are used to provide symptom relief after a migraine attack has already started. It’s FDA-approved for any adult patient who has migraine headaches with or without aura.

Every migraine patient should have a rescue medication strategy to treat breakthrough headaches, whether they happen once or twice a year, or once or twice a week. Here’s what you need to know about migraine treatment and zavegepant:

What safe and effective treatments are there for migraine?

 Migraine treatment options are divided into two big categories:

1. Treatment used for acute relief of breakthrough symptoms once a migraine has started
2. Treatment focused on preventing migraine attacks

For both categories, there are several treatments that have been shown to be well-tolerated, safe and effective, including:

• Over-the-counter medications
• Prescription strength medications
• Neuromodulation devices, which use electrical currents or magnets to affect brain activity

I recommend people discuss their migraine history and treatment plan with their medical provider. Together, you can decide which options are the most appropriate based on your headache features, other medications you take and your medical history.

What makes zavegepant different from other available migraine medications?

The critical difference between zavegepant and other acute or rescue medications is that it’s administered as a nasal spray. It’s the first and only nasal spray formulation in its medication family.

The ability to take rescue medication as a nasal spray is especially important for the large proportion of patients who have nausea and vomiting with their migraine attacks. It’s attractive to that subset of patients because you don’t need to take it orally.

But you don’t have to have nausea and vomiting to use zavegepant. The nasal spray formulation also helps the medication rapidly absorb into the system. That means it’s more likely to work quickly. In research trials, some patients had pain relief as early as 15 minutes after taking the medication. For migraine patients who may be at work or involved in family activities when a migraine attack happens, having a treatment option that can return them to normal function sooner rather than later is particularly helpful.

How does zavegepant work to treat migraine?

Zavegepant is an acute, also called rescue, medication. It does not prevent migraine. People use this medication to alleviate symptoms when they have a migraine attack.

While we don’t know everything about what causes migraine, we have learned a lot about what happens in the brain during migraine attacks in terms of what brain chemicals are involved, where they’re going and what they’re doing.

Scientists have identified a brain chemical called calcitonin gene-related peptide (CGRP) as a key player in the chemical changes that happen in the brain during migraine attacks. High levels of CGRP can promote inflammation and other chemical changes that lead to migraine pain, nausea and increased sensitivity to sound and light. Zavegepant blocks CGRP from attaching to its receptors and limits its activity.

Are there any side effects or safety concerns associated with zavegepant?

Some people don’t like taste or feel of nasal sprays. In research trials, the most reported side effects include:

• Discomfort in the nose
• Nausea
• Unpleasant taste in the mouth
• Vomiting

Most side effects noted were mild to moderate in intensity. To date, no serious adverse events have been reported.

Several classes of prescription medications may interact with zavegepant and other medicines in that family (CGRP receptor antagonists). Make sure to discuss all the prescription medications you take with your doctor or pharmacist.

How can people access this migraine treatment?

Zavegepant, marketed under the brand name Zavzpret™, is expected to be available in pharmacies this summer, hopefully by July 2023. Anybody who is a migraine sufferer managing symptoms on their own or using only over-the-counter medications should reach out to their doctor to discuss their current migraine treatment plan and see if they might benefit from prescription-strength rescue medication.

If you have moderate to severe headaches frequently (more than four or five headache days per month), then meeting with your healthcare provider to discuss preventive treatment options can be helpful. Zavegepant and other acute or rescue medications are designed to work with preventative medications if needed.

To learn more about the Inova Headache Program, go to inova.org/headache or to make an appointment call 703-472-4200.