Is the right way to go in between?: Rimegepant as needed provides preventive benefit. A comment on: monthly migraine days, tablet utilization, and quality of life associated with rimegepant—post hoc results from an open label safety study (BHV3000–201)

In the study by Johnston et al., gepants were meant to be taken to treat emergent migraine. It is tempting to speculate what the effect would be if patients were instructed to take a gepant as needed (PRN) or even prior to headache onset. While the latter sounds irrational at first glance, several studies have shown that a significant proportion of patients are quite proficient in predicting (or simply due to premonitory symptoms noting) their migraine attacks prior to the onset of actual headache. The study by Johnston et al. provides food for thought along these lines and should encourage us to further investigate flexible patient-controlled CGRP blocking as a third, intermediate and potentially cost-effective avenue between acute/rescue treatment and prevention/prophylaxis.