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

Most common
Nausea (up to 2.7%)

Ajovy

Most common
Injection site reactions (up to 45%)

Nurtec vs. Ajovy Dosage

Nurtec

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 75 mg At the start
Maximum dose 75 mg Same as starting
Dose changes None Fixed dose

Ajovy

Dosage
Dosage Table
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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