AJOVY FOR MIGRAINE PREVENTION: WHAT TO KNOW AND HOW TO GET IT

A new class of drugs created to prevent migraine attacks came on the scene in 2018, and experts now recommend them as a preferred or “first line” treatment. Fremanezumab-vfrm (Ajovy) is one of these drugs, and it’s the first and only treatment in its class approved for children with migraine as young as 6 years old!

Here’s what you need to know about the way Ajovy works to prevent migraine attacks and how you — or a young patient in your life — can try it.

What Is Ajovy?

Ajovy is a preventive migraine treatment that is administered via an injection once per month, or three injections quarterly, to reduce the frequency and severity of migraine attacks.

Available in several countries, Ajovy is recommended as a so-called first-line treatment by the members of the American Headache Society, the organization for headache experts in the United States. First-line preventive treatments are the ones headache experts consider safe and effective enough to prescribe as a patient’s first treatment for migraine prevention.

In August 2025, the U.S. Food and Drug Administration (FDA) expanded Ajovy’s approval to include episodic migraine patients ages 6 to 17 who weigh at least 45 kilograms (kg), or 99 pounds. Ajovy is now the only preventive treatment of its kind with FDA approval for use in patients under 18.

How Does Ajovy Work?

Ajovy is a brand-name monoclonal antibody (mAb) that targets calcitonin gene-related peptide (CGRP), a substance produced by nerve fibers. CGRP typically attaches to receptors on nerve cells, signaling pain and dilating blood vessels.

In migraine, CGRP overstimulates nerves around the trigeminal nerve and meninges (the thin layers of tissue surrounding the brain), causing inflammation and the unnecessary pain signals that are involved with migraine attacks. Ajovy works by attaching to CGRP, preventing it from binding to receptors and sensitizing the nerves involved in migraine attacks.

How Effective Is Ajovy for Migraine?

In clinical trials and after-market studies, Ajovy has been shown to be effective and tolerable for many people.

One study followed nearly 2,000 Ajovy users after its approval. Among the highlights:

• People with chronic migraine who took Ajovy every three months experienced an average of 7.2 fewer severe migraine days per month. 
• Those who used Ajovy every month experienced 8.1 fewer days per month.
• More than half of those people with chronic migraine had a reduction of migraine days of better than 50 percent.
• People with episodic migraine using Ajovy monthly had 5.1 fewer migraine days per month

“Ajovy has truly been life-changing for many of my patients living with migraine,” says Andrea D. Murphy, The 2024 double-blind study tracked 237 pediatric migraine patients who were assigned either Ajovy or a placebo for three months. The results:, a nationally board-certified nurse practitioner and certified headache specialist in South Windsor, Connecticut.

“For individuals who have cycled through numerous preventive options with limited success, having a treatment specifically designed to target CGRP (one of the migraine mechanisms) has provided meaningful reductions in migraine frequency and intensity,” says Murphy. “Beyond the numbers, patients often describe regaining a sense of control and being able to participate more fully in their work, family life, and social activities.”

Ajovy for Pediatric Patients

The FDA approved Ajovy to treat episodic migraine in patients ages 6 to 17 (who weigh at least 45 kg, or 99 pounds) based on the results of the SPACE study. The double-blind study, published in 2025, tracked 237 pediatric migraine patients who were assigned either Ajovy or a placebo for three months. The results:

• Ajovy reduced monthly migraine days (MMD) by 2.5 versus 1.4 for placebo.
• Nearly one-half — 47.2 percent — of children receiving Ajovy saw their attacks reduced by 50 percent or more, compared with 27 percent for placebo.
• Side effects in the Ajovy group were similar to those seen in the placebo group and were mostly mild.

Benefits were similar in children ages 6 to 11 and adolescents ages 12 to 17, as well as in boys and girls.

Murphy sees significant benefits to making Ajovy available for younger patients.

“Being able to offer migraine-specific preventive therapy at a younger age has the potential to dramatically reduce disease burden, improve quality of life, and lower the risk of progression to chronic migraine,” says Murphy. “For families who have watched their children struggle with missed school, disrupted activities, and frequent pain, having this option represents both hope and validation that migraine is a serious neurological disease worthy of targeted treatment.”

Ajovy for Migraine and Depression

Many people with migraine also live with depression, and Ajovy might be able to help with both. A randomized clinical trial published in 2025 found that Ajovy is effective in alleviating both migraine and major depressive disorder in patients with both conditions.

According to study authors, improvements in depression symptoms may be the indirect result of improvements in migraine symptoms, but emerging evidence suggests that CGRP pathways may also play a role in major depressive disorder.

Practical Tips for Starting Ajovy

How Much Does Ajovy Cost? Insurance Coverage and Ajovy

Ajovy is available by prescription only. Teva offers a discount program for patients in the United States covered by commercial insurance. You can find out more about the Ajovy coupon here. (The Ajovy coupon is not available for people using Medicare or Medicaid per U.S. law.)

The cost varies widely depending on your insurance coverage and other factors, but the wholesale cost in 2025 is around $483 per dose. People who rely on Medicare should be aware that Ajovy’s coverage depends on their Part D plan’s formulary, and it will almost certainly require prior authorization. Retail prices without insurance vary among pharmacies but may run as high as $900 per dose. Prescription discount services like SingleCare list prices for Ajovy in the range of $600 to $800.

Insurers often require that you have tried preventive treatments from two to three other classes of medication before they will approve a prior authorization for newer, expensive treatments like Ajovy. This practice, called step therapy, is as common as it is unpleasant. Some states now have laws regulating step therapy, and many healthcare providers have full-time staff dedicated to managing both it and the prior-authorization process. Make sure your healthcare provider has records of your other migraine prevention attempts.

The Coalition for Headache and Migraine Patients (CHAMP) has published the Financial Assistance Guides with valuable information on the different assistance programs available, as well as guides for navigating insurance coverage. However, note that CHAMP is based in the United States, so its guides are best suited for a U.S. audience.

How Ajovy Is Administered

Ajovy is an injectable treatment available in two forms: an auto-injector pen and a prefilled syringe, each loaded with a single 225 milligram dose of Ajovy. Ajovy must be refrigerated until you’re ready to use it. You can take a single injection once a month or three injections once every three months (talk to your healthcare provider about which option is best for you).

When you’re ready to use Ajovy, take the injection out of the refrigerator and let it sit at room temperature for at least 30 minutes. Then sterilize a spot on your upper thigh, upper arm, or abdomen with an alcohol wipe and inject Ajovy as directed into the sterilized location. (The Ajovy auto-injector and the prefilled syringe have different instructions for injection, so follow the instructions in the package insert and talk to your healthcare provider.)

Whether you use the auto-injector or the syringe, dispose of your injector in a safe sharps container. Your local department of public health may have one for no cost.

How Long Does Ajovy Take to Work?

The good news: For many people, Ajovy starts to work in the first month! In clinical trials, people with chronic migraine who used Ajovy reported a mean reduction of nearly five moderate- to severe headache days per month in the first month. Participants who responded well to Ajovy had additional improvement with continued use.

If you don’t respond to Ajovy right away, don’t give up! In a study published in 2023, half of the people who had no response to CGRP mAbs after 12 weeks turned out to be “late responders” who showed a positive response after 24 weeks or longer.

What Are the Side Effects of Ajovy?

Most side effects reported with Ajovy tend to be mild to moderate and tolerable. The most common side effects or adverse events (AEs) reported in clinical studies were injection site reactions (26 to 33 percent), such as pain, itching, swelling, or redness.

Other mild- to moderate side effects have emerged in postmarket studies and reports to the FDA Adverse Event Reporting System (FAERS):

Some Ajovy users report hair loss (alopecia). Evidence suggests the side effect is less common among Ajovy users than people who use other CGRP monoclonal antibodies, but individual reactions vary widely.

Ajovy has been associated with Raynaud’s disease, a disorder that causes spasms in small blood vessels in the extremities (like fingers, toes, nose, lips, earlobes) in reaction to things like cold temperatures and stress. The spasms limit blood flow to those areas, leading to color changes in the skin and a pins-and-needles sensation. Although Raynaud's can lead to tissue damage in extreme cases, many cases can be managed with modest lifestyle changes.

Serious side effects have been noted in FAERS. Although these side effects are extremely rare, you and your healthcare providers should know about them.

Allergic reaction may occur anywhere from the same day of injection to one month afterward. This may include anaphylaxis, a potentially life-threatening allergic reaction.

Ajovy and other migraine treatments targeting CGRP have been associated with a very small number of cases of sudden, severe hypertension (high blood pressure) of 180/120 or greater, even in people with no history of high blood pressure. Sudden severe hypertension may have symptoms like chest pain and shortness of breath or no symptoms at all — but it increases risk of stroke, heart attack, kidney failure, and other severe outcomes.

There is a potential risk connected to CGRP inhibitors of Stevens-Johnson syndrome, which causes severe rashes and blistering. The syndrome is almost always the result of an allergic reaction to medication. Although this risk is perceived to be very low, Stevens-Johnson syndrome can become life-threatening and requires prompt hospitalization.

What the Migraine Community Says About Ajovy

On the Migraine Again Facebook page, people shared their experiences with Ajovy.

Kristina S. had a great result:

It is amazing! It has completely changed my life after 30 years of migraines. This will not be the case for everyone. It took a few months to gradually work up to the results, so don't take one shot and expect a miracle. Each month, things improved. But now, I can live a normal life again. For the first time. I can plan things. Sometimes I still get migraines, every once in a while. But I can take a few aspirin and then it's gone in a few hours. I experience zero side effects as well (besides the shot hurting.)

Courtney S. had good results but changed from monthly to quarterly dosing:

It is the reason I can work again. The migraines are more controlled with Imitrex now. After years of taking the abortive medication, it stopped working. I could tell when I was due for Ajovy because the migraines would get worse. After about a year, Ajovy wasn't as effective as in the beginning, so now I do 3 shots at once and it lasts 3 months.

Angi G. had mixed results:

I’m on it currently. I still have daily headaches and bimonthly migraines, especially around week 3. However, it has helped my vertigo, or ocular migraines, according to my neurologist. So some improvement, but not at all the resolution as hoped.

Christie H. stopped taking Ajovy because of a side effect:

I tried Ajovy for 12 months, and it worked ok. It caused hair loss, which is reversing now that I'm not taking it.

Other Treatment Options for Migraine Relief

If Ajovy doesn’t give you the results you want, there’s still hope! There are three other CGRP monoclonal antibodies available and evidence suggests that you might get good results from one of them even if another CGRP mAb didn’t work for you.

You may get better results with combination therapy, using two or more preventive treatments at the same time (such as Ajovy and Botox). Talk to your healthcare provider about this technique; certain preventive treatments should not be used together or may be contraindicated for you, but many patients have found worthwhile relief using combination therapy.

Remember that nonmedication options like neuromodulation devices, supplements, physical therapy, and lifestyle changes can help, too, especially in combination with pharmaceutical options.

A Comparison of the Four CGRP mAbs for Migraine Prevention

Final Thoughts

Ajovy is a monoclonal antibody approved for the prevention of migraine in adults and in children ages 6 to 17 who weigh at least 45 kg (99 pounds). It’s an injectable treatment with two at-home dosing options: a single monthly shot or three shots given every three months.

Clinical trials and postmarket studies confirm Ajovy has been effective and tolerable for many people with migraine. Ajovy and the other CGRP monoclonal antibodies tend to have few interactions with other medications, making them excellent candidates for use in combination therapy for migraine. Many people notice results within the first month of Ajovy use, but some patients may be “late responders” who get a worthwhile response only after 6 to 12 months of use.

Side effects tend to be mild and tolerable. The most common side effect is injection site reaction, but cases of Raynaud’s disease and hair loss have been reported. Serious adverse events are extremely rare.

Many U.S. insurers now cover Ajovy, but you and your healthcare provider may have to do a lot of paperwork to get coverage. Financial assistance may be available through Ajovy’s manufacturer.

If you haven’t found the migraine relief you need, consider talking to your healthcare provider about Ajovy. With new treatments like Ajovy, increased awareness about migraine, and better resources for healthcare providers and patients, you have a better chance than ever before of finding the right approach for worthwhile migraine relief.

Have you tried Ajovy for migraine prevention? Share your best practices with other migraine warriors on TIPPI, a platform for giving and getting migraine tips.

2025-10-02T20:05:41Z