Now I’ve tried Ajovy too

Fremanezumab (Ajovy) is the second CGRP monoclonal antibody to become after the introduction of erenumab (Aimovig) and it has some differentiating features. I injected myself with Aimovig twice and was able to drink more wine with relative impunity. The relief from my migraines was not complete, but very significant. However, I did experience constipation, which was quite unpleasant. Constipation is the only side effect of Aimovig reported with any frequency besides injection site reactions (an allergic rash can also occur). As one gets older (and I am 62), constipation becomes more prevalent. Although I could manage the constipation, it took an effort and I did not continue with Aimovig. My migraines are not at all disabling and I just cut back on wine. Besides wine, sleep deprivation and certain foods trigger my migraines, but they are easily managed with sumatriptan tablets or when I want fast onset of action, with sumatriptan injections.

After a couple of months, I decided to try Ajovy and took a shot on November 6. It worked at least as well as Aimovig and did not cause constipation. The effect lasted exactly a month and then migraines returned, so I took a second shot on December 13. Both Ajovy injections started to work within a day, although in some of my patients it takes a week.

I continue to prescribe Aimovig as well as Ajovy and sometimes, the third drug in this family, galcanezumab (Emgality). If someone is prone to constipation, my first choice is definitely Ajovy. Another small difference is the mode of delivery. You can give yourself a shot of Aimovig (and Emgality) with a push of a button, while Ajovy comes in a pre-filled syringe. Some patients find autoinjectors painful and opt for the prefilled syringe of Ajovy . Others, do not want to see the needle and prefer Aimovig’s pen-like device. One additional advantage of Ajovy is that it can be given every 3 months, although it requires 3 shots each time. Some of our patients who do not like giving themselves any kind of an injection opt for coming for a visit every 3 months and having our doctors or nurse practitioners administer Ajovy.

We have treated hundreds of patients with Aimovig and Ajovy and a few dozen with Emgality. Some who did not respond to Aimovig (we usually give two sets of monthly injections before giving up), responded well to Ajovy. This is probably due to the fact that they have a slightly different mechanism of action. Both are monoclonal antibodies that block the effect of CGRP, a neurotransmitter which is released during a migraine attack, but Aimovig blocks the CGRP receptor, while Ajovy (and Emgality) block the CGRP molecule. This difference may also explain why Aimovig constipates and the other two drugs do not.

About one fifth of patients have a dramatic relief from these medications, while about 50% have a 50% drop in the number of headaches. Some patients in the latter group may require continued treatment with Botox or oral medications, but together these treatments also result in a marked reduction in migraine-related disability. We also continue to prescribe abortive drugs such as sumatriptan (Imitrex) to all patients because even in complete responders an occasional migraine can still occur.

26 comments
  1. Dr. Mauskop says: 01/28/20242:24 pm

    It is possible that the effect of the previous injection wears off and it takes a few days for the new shot to take effect. Some people need to inject Ajovy, Emgality and Aimovig a few days earlier to avoid the end-of-dose wearing off effect.

  2. Rachel says: 01/28/20241:59 am

    Hello. I’ve been using Ajovy for just over a year and had very good results and minimal adverse reactions. I’m starting to wonder if it may be causing me to experience headaches in the days immediately following the injection. Is this something you’ve seen in your patients? Thank you.

  3. Dr. Mauskop says: 12/16/202310:49 pm

    It can stop working, especially if there are changes in a person’s health – thyroid disease, magnesium deficiency, another illness, stress, etc

  4. Bali Athwal says: 12/16/20237:28 pm

    Does Ajovy ever stop working? I have been on it for 11 months and had an excellent response to it. It started working after one day and reduced my headaches to almost zero combined with Botox and topimax. I had no brain fog either. I am a 53 year old female. Then all of sudden I went into status and now I have migraines almost every other day. I am really struggling.

  5. Dr. Mauskop says: 05/18/20225:09 pm

    I would keep fighting your insurance and you should prevail in getting Emgality approved.

  6. Carrie says: 05/18/20222:43 pm

    I found your article today as I was researching what happens when you switch from Emgality to Ajovy or Aimovig. I don’t want to switch, I am a super-responder with 90%+ Migraine clearance. However, my insurance changed the Tier price from a level 3 to 4, without reason. Even after an hour long phone call, I was instructed to just file a grievance. I am not sure how long my copay card will last with Eli Lily, but I don’t want to give up Emgality just as I got my life back. I have no side effects with Emgality, but have had major side effects with all previous migraine meds and I have a family history of severe Alopecia and Constipation. I am worried about switching to other meds that list those as a high % of side effects.

  7. Becka says: 03/22/20224:47 pm

    So my daughter just started this last week, Friday and is having awful stomach cramping, not sure if she has noticed an improvement in daily headaches, the cramping is nausea related but normal bathroom, started 2 days ago, the only other medicine she is on is Botox shots and the ajovy

  8. Kathy says: 04/09/202111:41 am

    Just started Ajovy this week – I think my headaches are not as severe but so far not fewer than taking just Propranolol 160 mg. Hoping the next dose will help reduce the number of days.

  9. Anonymous says: 03/24/20215:24 pm

    Hi. Has anyone seen improvement in migraine related vertigo with Ajovy ? If yes how long did it take?

  10. Dr. Mauskop says: 03/22/20218:48 am

    Unfortunately, Ajovy and similar drugs work well for about 50% of people. It may be worth trying Aimovig (erenumab) because it has a somewhat different mechanism of action and could help even if Ajovy does not.

  11. Rado says: 03/22/20214:35 am

    Hello, I got 3 injections of Ajovy 08/03/2021 and till now for 14 days I had 8 days migraine, Ajovy does not work, please can you recommend me something that should help me. I having about 20 days of migraines per month. Why Ajovy does not work? Please help me.

  12. Dr. Mauskop says: 01/09/202111:15 pm

    Even if you gave me more information about your headaches, unfortunately, I could give you advice without first seeing you in person or by video.

  13. MH says: 01/09/202112:22 am

    Dear Dr. I am having different type migraine . My head back and both side is constantly burning and heated up. Forehead I dont feel anything. My doctor said its tension migraine. He recommend me Ajoby. I am still afraid. Please advise me should I take it? When i was making comment my head/brain is like burning/heated up and feeling nausea. Thank you so much.

  14. Deborah M says: 12/01/20205:06 am

    Thank you for posting this I have had problems with diarrhea for going on 20 years from gastric Behcet’s syndrome and when I first started Aimovig and it caused constipation I was actually happy. It’s stopped my daily migraines but as time goes on I’m having a really hard time getting the dosage correct to not have constipation and diarrhea at the same time which is really horrible! I’m going to ask to change to Ajovy but I’m not sure if I can because it’s not in my insurance companies drug plan, which I don’t understand why they cover only one. Is it because Aimovig is an older drug and less expensive?

  15. Dr. Mauskop says: 02/02/20209:38 pm

    Most of the neurologists and even primary care doctors who treat many headache patients get a generous supply of Ajovy, so if you see your doctor once a month you could ask for an injection of a free sample. Medicare will pay the doctor for the visit and you will get a free shot.

  16. Elaine Woodmansee says: 02/02/20203:58 pm

    I have had migraines for about 30 yrs. I took Ajovy for six months, what a dramatic reduction in the number of headache days. Since I am now on Medicare and my private drug plan does not cover Ajovy I will have to stop taking the shots. All of the coupons and discounts are for people that do NOT need them. I am not sure what to do now.

  17. Dr. Mauskop says: 06/20/20198:57 pm

    Yes, Ajovy could cause the same side effects as Emgality since they have a similar mechanism of action, which is somewhat different from Aimovig. Botox on the other hand, is much less likely to cause side effects.

  18. Steph says: 06/20/20197:27 pm

    I’ve tried Aimovig and still had numerous migraines along with constipation and back pain.
    Three months later, I tried Emgality. Huge difference with only 3 days of migraines that I can manage. The only problem is constipation and back pain again. Tried everything, olive oil, flax, dulcolax, treadmill and still slow digestion. If Emgality is causing constipation, should I just forget about Ajovy or just go to Botox? Thanks

  19. Gerardo Martinez says: 12/22/20187:51 pm

    I’m a patient of the NY Headache center. I’ve tried all three CGRP inhibitors in the market already. Had to discontinue Aimovig due to constipation side effect but it did work in reducing migraines specially after the second dose. I had a reduction of more than 70% and also triptans worked faster. One thing I noticed while using Aimovig was a significant reduction in brain fog. I felt much more focused and had more concentration. Then I tried one shot of Ajovy which unfortunately gave me an allergic reaction. I was very itchy for a few days and one night I felt very anxious and also with too much chest pressure. I started taking Benadryl and I felt much better. However Ajovy worked really well for three weeks and reduced my migraines even more, I had a reduction of 90% in migraine days and NO constipation! Because of the allergic reaction I was switched to Emgality which also works quite well but got me costipated for about two weeks after the second dose. I will continue taking Emgality every three to four weeks and Botox injections every three months. I haven’t felt this well in a long time! I’m glad I found a headache specialist after so long. Thank you Dr. Mauskop.

  20. Ellen says: 12/19/20189:53 pm

    Thank you for posting about your experience with Ajovy. I am a chronic migraine patient and have taken two doses of Aimovig (Nov 1 and Dec 1) and am very pleased with the results. I have failed many preventive drugs in the past (no improvement and terrible side effects), but Aimovig has reduced my medication days each month by approximately 50 percent, which feels like a miracle. No side effects so far, but it’s great to know that Ajovy and Emgality are good alternatives.

  21. Dr. Mauskop says: 12/17/20184:19 pm

    Yes, two companies are developing CGRP antagonists for abortive therapy of migraine and they both will be available in a pill form. Rimegepant is being developed by Biohaven and ubrogepant by Allergan and both are expected to be approved in the first quarter of 2020.

  22. Maria says: 12/17/201812:19 pm

    I heard that there will be an abortive CGRP medication in the future. Do you know anything about it? Thank you

  23. Dr. Mauskop says: 12/16/201810:27 pm

    Yes, chronic posttraumatic migraines can also respond to Ajovy and other CGRP monoclonal antibodies.

  24. Helenjones says: 12/16/20186:37 pm

    Do you have any experience of Ajovy on patients who have constant chronic post traumatic migraine triggered as a result of an object falling on their head ….bad reactions to botox and all meds tried or they have no effect at all and only thing which gives a modicum of relief is nerve block ….does also having an autoimmune disease make CGRP more complicated

  25. Dr. Mauskop says: 12/15/201811:14 pm

    If you have 60% improvement with Aimovig, you may want to continue with it to see if your migraines continue to improve. If they don’t, then it may be worth trying Ajovy.

  26. Maria says: 12/15/201810:40 pm

    Thank you for the information. I have received four Aimovig injections and I didn’t noticed a significant improvement until two weeks after the third injection. I got a 60% improvement in frequency and also the migraines seem to be a bit milder.
    I have also read that some headache specialists try doubling the dose before considering it treatment failure.
    If we do experience some relief with Aimovig, do you think it’s worth trying Ajovi to see if the improvement is greater or only if you experience constipation?
    Thank you

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