Zomig vs. Ajovy

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

Key Takeaways

  • Zomig is a triptan taken at the first sign of a migraine to stop an attack already underway, while Ajovy is injected monthly or quarterly to prevent migraines before they start.

  • Zomig works within hours and comes as a tablet, dissolving tablet, or nasal spray, while Ajovy takes weeks to build effect but only needs dosing up to 12 times a year.

  • Zomig carries cardiovascular risks that rule it out for patients with heart disease, while Ajovy's main downside is injection site reactions, which affect nearly half of users.

Zomig vs. Ajovy Drug Summary

Zomig

Zomig (zolmitriptan) is a triptan that treats migraine attacks that have already started, working on serotonin receptors to narrow blood vessels and block pain signals. It comes as a tablet, an orally disintegrating tablet, or a nasal spray, and is taken as needed at the first sign of a migraine, with a second dose allowed after two hours if symptoms return.

Ajovy

Ajovy (fremanezumab-vfrm) is a CGRP-blocking monoclonal antibody used to prevent migraines before they start, rather than treat an attack in progress. It's given as a subcutaneous injection, either 225 mg once a month or 675 mg once every three months, and is also approved for adolescents 6 to 17 who weigh at least 45 kg.

Zomig vs. Ajovy Side Effects

Zomig

Most common
asthenia (up to 14%)

Ajovy

Most common
injection site reactions (38% to 45%)

Zomig vs. Ajovy Dosage

Zomig

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1.25 mg or 2.5 mg At the start
Maximum dose 5 mg single dose 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

Zomig vs. Ajovy Indications

Zomig

Zomig is FDA-approved for the acute treatment of migraine attacks in adults, with or without aura. It's meant to stop a migraine once it starts, not to prevent future attacks.

  • Migraine with aura

  • Migraine without aura

  • Taken at the first sign of an attack

  • Not approved for migraine prevention

  • Not approved for cluster headache

Ajovy

Ajovy is FDA-approved to prevent migraines before they start, in adults with episodic or chronic migraine. It's also approved for adolescents 6 to 17 years old who weigh at least 45 kg.

  • Episodic migraine prevention

  • Chronic migraine prevention

  • Adolescents 6 to 17 years old (≥45 kg)

  • Not approved to treat an active attack

  • Not approved for cluster headache prevention

Zomig vs. Ajovy Pros and Cons

Zomig

Zomig acts quickly to relieve migraine pain and related symptoms once an attack has begun, and its three formulations give patients flexibility if nausea makes swallowing pills difficult. It isn't suitable for anyone with cardiovascular disease, and it doesn't reduce how often migraines occur.

Pros

  • Works within an hour for many patients

  • Available as tablet, dissolving tablet, or nasal spray

  • Taken only when needed, not daily

  • Second dose allowed if migraine returns

Cons

  • Contraindicated in heart disease and stroke risk

  • Does not prevent future migraines

  • Risk of medication overuse headache with frequent use

  • Effects fade within hours, may need redosing

Ajovy

Ajovy targets the CGRP pathway thought to drive migraine frequency, reducing how many attacks a person has over time rather than treating one in progress. Its infrequent dosing schedule appeals to patients who want to avoid daily pills, though it requires self-injection and doesn't help during an active attack.

Pros

  • Only 4 to 12 doses needed per year

  • Prevents migraines rather than just treating them

  • Approved for adolescents 6 to 17 (≥45 kg)

  • Long half-life keeps levels steady between doses

Cons

  • Given by injection, not a pill or spray

  • Injection site reactions occur in 38% to 45%

  • Does not treat a migraine once it starts

  • Risk of hypersensitivity reactions including anaphylaxis

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