Zomig vs. Emgality

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

Key Takeaways

  • Zomig is taken as needed to stop a migraine once it starts, while Emgality is injected monthly to prevent migraines before they begin.

  • Zomig comes in tablet, dissolving tablet, and nasal spray forms, while Emgality is only available as a once-monthly injection.

  • Emgality has no cardiovascular restrictions the way Zomig does, but Zomig can relieve an attack within hours while Emgality takes weeks to build its preventive effect.

Zomig vs. Emgality Drug Summary

Zomig

Zomig (zolmitriptan) is a triptan that treats acute migraine attacks by narrowing blood vessels and blocking pain signals in the brain. It comes as a tablet, an orally disintegrating tablet, or a nasal spray, and is taken as needed when a migraine starts, not on a daily schedule.

Emgality

Emgality (galcanezumab-gnlm) is a monoclonal antibody that blocks calcitonin gene-related peptide (CGRP) to prevent migraines before they occur. It's given as a once-monthly injection under the skin, with a double dose in the first month, and is also approved for episodic cluster headache.

Zomig vs. Emgality Side Effects

Zomig

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

Emgality

Most common
injection site reactions (up to 18%)
injection site pain (10.1% to 11.6%)
constipation (1.0% to 1.5%)
vertigo (0.7% to 1.2%)

Zomig vs. Emgality 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

Emgality

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 240 mg Day 1
Maximum dose 300 mg once monthly If needed
Dose changes 2 increases As tolerated

Zomig vs. Emgality Indications

Zomig

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

  • Acute treatment of migraine with or without aura

  • Taken at the first sign of a migraine attack

  • Available as tablet, orally disintegrating tablet, or nasal spray

  • Not approved for migraine prevention or cluster headache

Emgality

Emgality is FDA-approved for the preventive treatment of migraine in adults and for episodic cluster headache. It's meant to reduce how often attacks happen, not to relieve one once it starts.

  • Preventive treatment of migraine

  • Treatment of episodic cluster headache

  • Given as a once-monthly injection

  • Not approved for acute migraine relief

Zomig vs. Emgality Pros and Cons

Zomig

Zomig acts quickly to relieve pain, nausea, and light sensitivity once a migraine has started, and it comes in three formulations to fit different needs. It isn't a preventive option, and its vasoconstrictive action means it can't be used by people with cardiovascular disease.

Pros

  • Works within hours to stop an active migraine attack

  • Three formulations: tablet, ODT, and nasal spray

  • Nasal spray option when nausea makes pills hard to keep down

  • Available as a generic, often $13 to $100 a month, far less than Emgality's $650 to $900

Cons

  • Contraindicated in patients with heart disease or stroke history

  • Not approved for migraine prevention

  • Frequent use raises risk of medication overuse headache

  • May need a second dose if the first doesn't fully work

Emgality

Emgality works in the background to lower how many migraine or cluster headache days a person has, rather than treating attacks as they happen. It avoids the cardiovascular restrictions of triptans, but it takes weeks to reach full effect and does nothing during an active attack.

Pros

  • Once-monthly injection instead of dosing for each attack

  • No cardiovascular contraindications, unlike triptans

  • Also approved for episodic cluster headache

  • No boxed warning on the label

Cons

  • Injection site reactions are common

  • Does not treat an attack once it has started

  • Takes weeks to build up its preventive effect

  • Costs roughly $650 to $900 a month, much higher than generic zolmitriptan

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