Sumatriptan vs. Ajovy
See how Sumatriptan and Ajovy compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Sumatriptan is taken as needed to stop a migraine attack already underway, while Ajovy is injected on a schedule to prevent attacks before they start.
Sumatriptan is an inexpensive tablet kept on hand for attacks, while Ajovy is a monthly or quarterly injection prescribed for ongoing prevention.
Many patients use both together: sumatriptan for acute relief during an attack, and Ajovy to reduce how often migraines occur over time.
Sumatriptan vs. Ajovy Drug Summary
Sumatriptan
Sumatriptan is a triptan, a serotonin 5-HT1B/1D receptor agonist, used to stop a migraine attack that has already started. It's usually taken as an oral tablet at the first sign of a migraine, with a repeat dose allowed if symptoms return, and is also available as an injection or nasal spray. It does not prevent future attacks.
Ajovy
Ajovy is a CGRP monoclonal antibody injected under the skin to prevent migraines before they start, rather than treat an attack in progress. It's given as a monthly 225 mg injection or a quarterly 675 mg injection using a prefilled syringe or autoinjector. It is not used for acute migraine relief.
Sumatriptan vs. Ajovy Side Effects
Sumatriptan
Ajovy
Sumatriptan vs. Ajovy Dosage
Sumatriptan
Ajovy
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once per attack | At the start |
| Maximum dose | 100 mg once per attack | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 225 mg once monthly | At the start |
| Maximum dose | 675 mg every 3 months | If needed |
| Dose changes | 1 increase | As tolerated |
Sumatriptan
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once per attack | At the start |
| Maximum dose | 100 mg once per attack | If needed |
| Dose changes | 2 increases | As tolerated |
Ajovy
| STAGE | DOSE | WHEN |
| Starting dose | 225 mg once monthly | At the start |
| Maximum dose | 675 mg every 3 months | If needed |
| Dose changes | 1 increase | As tolerated |
Sumatriptan vs. Ajovy Indications
Sumatriptan
Sumatriptan is FDA-approved for the acute treatment of migraine with or without aura in adults. It's meant to be taken once a migraine has started, not to prevent one. It is not approved for cluster headache in tablet form or for daily preventive use.
Acute treatment of migraine attacks in adults
Works for migraine with or without aura
Taken at the onset of migraine symptoms
Not for migraine prevention
Ajovy
Ajovy is FDA-approved for the preventive treatment of migraine in adults, and in children 6 to 17 years old weighing at least 45 kg. It's injected on a schedule to reduce how often migraines occur, not to treat an attack once it starts. It is not approved for acute migraine relief.
Preventive treatment of migraine in adults
Approved for adolescents 6-17 weighing 45 kg+
Reduces migraine frequency over time
Not for treating an active migraine attack
Sumatriptan vs. Ajovy Pros and Cons
Sumatriptan
Sumatriptan is one of the original triptans, available as an inexpensive generic tablet that most insurance plans cover with minimal restrictions. It treats an attack already in progress rather than preventing future ones, so it's often used alongside preventive options like Ajovy rather than replacing them.
Pros
Available as low-cost generic tablet
Works within 1-2 hours to relieve an active migraine
Also available as injection or nasal spray for faster relief
Decades of real-world safety data since 1992 approval
Cons
Contraindicated with history of heart disease or stroke
Risk of serotonin syndrome with other serotonergic drugs
Doesn't reduce how often migraines occur
Cannot be combined with ergotamines or other triptans within 24 hours
Ajovy
Ajovy targets the CGRP pathway thought to drive migraine frequency, giving patients with frequent or disabling migraines a preventive option. It requires a scheduled injection rather than a pill, and like other CGRP antibodies it carries a much higher list price than older oral treatments.
Pros
Reduces migraine frequency with ongoing use
Only needs to be injected monthly or once every 3 months
No known cardiovascular contraindications like triptans
Long-acting, with effects lasting weeks after each dose
Cons
Roughly $690 to $1,046 per month without insurance, well above sumatriptan's cost
Injection site reactions occur in up to 45% of patients
Can cause new or worsening Raynaud's phenomenon
No generic or biosimilar version available
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