Acute Migraine Treatment in the ED With Gepants

Inclusion Criteria: * At least 18 years of age * Capacity to provide informed consent (without a Legally Authorized Representative) * Prior migraine diagnosis (clinical or self-reported) * Emergency Department presentation for a headache fulfilling International Classification of Headache Disorders (ICHD-3) criteria for migraine with typical aura or without aura, or criteria for probable migraine with typical aura or without aura. Duration of migraines should be ≥ 1 year. It is acceptable if current headache duration is \>72 hours. Must have been headache free for \>48 hours prior to current attack. * Willingness to participate in post-discharge telephone or electronic follow-up assessments Exclusion Criteria: * Suspected secondary headache due to another cause, or primary headache disorder other than migraine or probable migraine * Prior healthcare encounter for headache within 7 days * Use of analgesics or abortive headache medications within 2 hours of consent * Use of intranasal decongestant within 12 hours of consent * Use of the following drug/food categories with potential for drug interactions within 7 days or 5 half-lives, whichever is longer: 1) CYP3A strong or moderate inducers, 2) CYP3A4 strong inhibitors, 3) P-glycoprotein (P-gp) inhibitors, 4) OATP1B3 transporter potent inhibitors/inducers, 5) NTCP transporter potent inhibitors/inducers * History of cardiovascular disease, hypertension, or diabetes, recently diagnosed or currently uncontrolled or unstable * History of stroke, peripheral vascular disease, or medically-diagnosed Raynaud's Phenomenon * History of severe hepatic impairment, as assessed by the investigator or qualified delegate * History of kidney disease stage 4 (creatinine clearance \<30 mL/min or eGFR \<35 mL/min/1.73 m2) * History of nasal condition that may affect zavegepant administration, as assessed by the investigator or qualified delegate * History of hypersensitivity reaction to rimegepant, zavegepant, or to any included inactive ingredients * Lifetime use of CGRP-targeting acute or preventive migraine medications * In custody of law enforcement * Current pregnancy or lactation