2026 American Academy of Neurology Abstract Website

Karin Hygge Blakeman¹, Alexandre Urani², Giorgio Lambru³, Richard Lipton⁴, Peter Goadsby⁵, Patricia Pozo-Rosich⁶, Todd Schwedt⁷, Kristina Fanning⁸, Feng Dai⁹, Lucy Abraham¹⁰
¹Pfizer AB., ²Aptar Digital Health, ³The Headache and Facial Pain Service, Guy's and St. Thomas' NHS Foundation Trust, ⁴Montefiore Medical Center and Albert Einstein College of Medicine, ⁵NIHR King’s Clinical Research Facility, King’s College Hospital/SLaM Biomedical Research Centre, King’s College London, ⁶Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, ⁷Department of Neurology, Mayo Clinic, ⁸MIST Reserach, ⁹Pfizer Inc., ¹⁰Pfizer R&D UK Ltd.

Objective:

Understand the reasons for triptan discontinuation in people using rimegepant for the acute treatment of migraine.

Background:

CONFIDENCE was a prospective observational study conducted via the Migraine Buddy® app to evaluate the real-world use of rimegepant for the acute treatment of migraine.

Design/Methods:

The study enrolled US adults with 3–14 headache days in the prior 30 days and plans to use rimegepant in the subsequent 30 days. At enrolment, participants reported the number of triptans previously used and discontinued (lapsed), and the reasons behind these lapses (all that applied from 9 items).

Results:

Among the 416 participants in the CONFIDENCE study, 46 (11%) had no lapsed triptans, 132 (32%) had 1, 134 (32%) had 2, and 104 (25%) had ≥3. 103/370 (28%) participants with ≥1 lapsed triptan currently used another triptan. Among participants with responses, the most common reasons for prior triptan lapses were insufficient headache pain reduction (66%), side effects (50%), not working as well as it used to (28%), and not working quickly enough (28%). Insufficient pain reduction (59% of those with 1 lapsed triptan, 65% with 2, 77% with ≥3; linear by linear association p=0.004), not working as well as it used to (23%, 28%, 36%; p=0.033), and not working quickly enough (20%, 34%, 32%; p=0.034) were reasons generally reported by higher proportions of participants with higher numbers of lapsed triptans. Similar proportions of participants who had lapsed 1, 2, or ≥3 triptans reported side effects (45%, 54%, and 49%; p=0.481).

Conclusions:

Insufficient pain reduction, side effects, not working as well as it used to, and not working quickly enough were common reasons for triptan lapse. Side effects were reported by ~50% of participants, irrespective of how many triptans had lapsed. The other three most common reasons were more frequently reported in participants with more lapsed triptans. NCT06467370