Nurtec vs. Ajovy
See how Nurtec and Ajovy compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Nurtec is a pill that can treat an active migraine attack and prevent future ones, while Ajovy is an injection approved only for prevention.
Nurtec is dosed as needed or every other day, while Ajovy is injected just once a month or once every three months.
Both target the CGRP pathway linked to migraine, but Nurtec is a small-molecule tablet and Ajovy is a monoclonal antibody injection.
Nurtec vs. Ajovy Drug Summary
Nurtec
Nurtec (rimegepant) is a CGRP receptor antagonist taken as an orally disintegrating tablet. It is the only oral CGRP medication FDA-approved to both treat a migraine attack as it happens and prevent future episodic migraines using the same tablet. Patients take it either as needed for an attack or every other day for prevention, up to a 75 mg daily maximum.
Ajovy
Ajovy (fremanezumab-vfrm) is a CGRP-targeting monoclonal antibody given as a self-injection under the skin. It is FDA-approved only for migraine prevention, not for stopping an attack already in progress, and is dosed once a month or once every three months. Its long half-life of about 30 days keeps drug levels steady between injections.
Nurtec vs. Ajovy Side Effects
Nurtec
Ajovy
Nurtec vs. Ajovy Dosage
Nurtec
Ajovy
| STAGE | DOSE | WHEN |
| Starting dose | 75 mg | At the start |
| Maximum dose | 75 mg | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 225 mg | At the start |
| Maximum dose | 675 mg | If needed |
| Dose changes | 1 increase | As tolerated |
Nurtec
| STAGE | DOSE | WHEN |
| Starting dose | 75 mg | At the start |
| Maximum dose | 75 mg | Same as starting |
| Dose changes | None | Fixed dose |
Ajovy
| STAGE | DOSE | WHEN |
| Starting dose | 225 mg | At the start |
| Maximum dose | 675 mg | If needed |
| Dose changes | 1 increase | As tolerated |
Nurtec vs. Ajovy Indications
Nurtec
Nurtec is FDA-approved for two distinct uses: treating a migraine attack once it starts, and preventing episodic migraines before they occur. It is not approved for chronic migraine (15 or more headache days a month) or for cluster headache.
Acute treatment of a migraine attack
Preventive treatment of episodic migraine
Not approved for chronic migraine prevention
Not approved for cluster headache
Ajovy
Ajovy is FDA-approved only for migraine prevention, covering both episodic and chronic migraine, in adults and in adolescents 6 to 17 who weigh at least 45 kg. It is not approved to treat a migraine attack that has already started.
Preventive treatment of episodic and chronic migraine
Approved for adolescents 6-17 years old (45+ kg)
Not approved for acute treatment of an attack
Offers monthly or quarterly injection schedule
Nurtec vs. Ajovy Pros and Cons
Nurtec
Nurtec's dual approval for treating attacks and preventing episodic migraine, combined with its pill form, appeals to patients who want one medication for both needs and prefer to avoid injections. Its main tradeoffs are more frequent dosing and a drug interaction to watch for with certain medications.
Pros
Oral tablet, no needles or injections required
FDA-approved to both treat an active attack and prevent future ones
Flexible as-needed dosing for acute attacks
Fast-dissolving tablet that works without water
Cons
Not approved for chronic migraine prevention
Must be taken as needed or every other day, more often than Ajovy
Interacts with strong CYP3A4 inhibitors, limiting some drug combos
Ajovy
Ajovy's monthly or quarterly injection schedule and broader prevention approval, covering both episodic and chronic migraine, suit patients who want infrequent dosing and don't need an acute-attack option. Its main tradeoff is a high rate of injection site reactions and no option for treating an attack in progress.
Pros
Only needs an injection once a month or once every 3 months
Approved to prevent both episodic and chronic migraine
Approved for adolescents 6 to 17 years old
Long half-life of about 30 days keeps levels steady
Cons
Not approved for treating a migraine attack in progress
Injection site reactions occur in up to 45% of patients
Requires a self-injection rather than a pill
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