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

Most common
Paresthesia (2%+)

Ajovy

Most common
Injection site reactions (45%)

Sumatriptan vs. Ajovy Dosage

Sumatriptan

Dosage
Dosage Table
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

Dosage
Dosage Table
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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