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
Ajovy
Zomig vs. Ajovy Dosage
Zomig
Ajovy
| 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 |
| 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
| 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
| 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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