Zomig vs. Aimovig

See how Zomig and Aimovig compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Zomig treats a migraine attack after it starts, while Aimovig is taken monthly to help prevent migraines before they begin.

  • Zomig comes as a tablet, dissolving tablet, or nasal spray for use as needed, while Aimovig is a once-monthly self-injection.

  • Zomig carries cardiovascular warnings that Aimovig does not, since Aimovig works through a different, non-vasoconstricting mechanism.

Zomig vs. Aimovig Drug Summary

Zomig

Zomig (zolmitriptan) is a triptan that treats a migraine attack once it has started by narrowing blood vessels and blocking pain signals in the brain. It's taken as needed as a tablet, a dissolving tablet, or a nasal spray, with an option to repeat the dose after two hours if the headache returns.

Aimovig

Aimovig (erenumab-aooe) is a monoclonal antibody that blocks the CGRP receptor to help prevent migraines before they start. It's given as a subcutaneous injection once a month, at a dose of 70 mg or 140 mg, using a prefilled autoinjector or syringe.

Zomig vs. Aimovig Side Effects

Zomig

Most common
asthenia (up to 14%)
nausea (up to 12%)
paresthesia (up to 11%)
dizziness (up to 11%)

Aimovig

Most common
injection site reactions (5-6%)
constipation (up to 3%)
cramps/muscle spasms (up to 2%)
vertigo (up to 2%)

Zomig vs. Aimovig Dosage

Zomig

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1.25 mg or 2.5 mg At the start
Maximum dose 5 mg as single dose If needed
Dose changes 2 increases As tolerated

Aimovig

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 70 mg once monthly At the start
Maximum dose 140 mg once monthly If needed
Dose changes 1 increase As tolerated

Zomig vs. Aimovig Indications

Zomig

Zomig is FDA-approved to treat a migraine attack with or without aura, in adults, once it has already started. It is not approved to prevent migraines, treat cluster headaches, or for use in children under 12 with the tablet or ODT forms.

  • Treats an active migraine attack, not prevention

  • Approved for adults with or without aura

  • Available as tablet, ODT, or nasal spray

  • Not approved for cluster headache

  • Tablet/ODT not approved under age 12

Aimovig

Aimovig is FDA-approved for the preventive treatment of migraine in adults, meaning it's taken regularly to reduce how often migraines occur. It is not intended to stop an attack that has already started.

  • Prevents migraines rather than treating an attack

  • Approved for adults only

  • Given as a once-monthly injection

  • Not approved for acute migraine treatment

  • No pediatric indication established

Zomig vs. Aimovig Pros and Cons

Zomig

Zomig offers fast relief once a migraine starts and comes in multiple forms, including a nasal spray for people who have trouble swallowing during an attack. Its cardiovascular warnings mean it isn't an option for everyone, and it does nothing to reduce how often migraines occur.

Pros

  • Available as tablet, ODT, or nasal spray

  • Taken as needed, no daily routine required

  • Generic version available, roughly $13 to $1,332 a month depending on formulation

  • Can be redosed after 2 hours if a migraine returns

Cons

  • Contraindicated in patients with cardiovascular disease

  • Risk of medication overuse headache with frequent use

  • Not approved for migraine prevention

  • Serotonin syndrome risk when combined with SSRIs/SNRIs

Aimovig

Aimovig targets the CGRP pathway to help prevent migraines before they start, requiring just one injection a month instead of daily or as-needed dosing. It lacks the cardiovascular warnings seen with triptans, but it comes with a higher price tag and no generic option.

Pros

  • Only one injection needed per month

  • No cardiovascular contraindications like triptans

  • Fewer and milder reported side effects overall

  • May reduce reliance on acute migraine medication

Cons

  • No generic option, roughly $783 to $943 a month without insurance

  • Requires self-injection rather than a pill

  • Does not treat a migraine attack once it starts

  • Postmarketing reports of severe constipation and hypersensitivity

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