Gepants in Primary Care: A Targeted Approach to Acute and Preventive Treatment of Migraine.

With 80% of migraines diagnosed and managed by primary care clinicians, a knowledge of standard of care and novel therapy is essential for those caring for people with this chronic disease. This review describes a new class of medication, calcitonin gene-related protein (CGRP) antagonists, known as gepants and their use with the focus on the general class of gepants rather than any specific type. These medications were developed specifically for acute and preventive treatment of migraine and appear to be more tolerable with fewer side effects than standard-of-care medications. Previous standard-of-care medications were developed for managing non-migraine disorders but were found to demonstrate efficacy in migraine control despite not directly targeting migraine pathophysiology. Evidence-informed review of the literature and real-world application of gepants is presented to provide a solid understanding of the class and guidance for use.