What to Know About Ajovy (Fremanezumab-vfrm)

An Injectable Medication for Migraine Prevention

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Ajovy (fremanezumab-vfrm) is a prescription medication used for migraine prevention. It is taken as an injection with an every month option and an every three-month option. There are no generic forms of fremanezumab-vfrm. It is only available as the brand Ajovy.

Ajovy is a monoclonal antibody that counteracts the action of calcitonin gene-related peptide (CGRP), a chemical that is elevated during migraine attacks. Several medications that have the same mechanism of action as Ajovy were approved for use in migraine prevention during 2018 and 2019.

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Ajovy was approved by the U.S. Food and Drug Administration (FDA) in 2018 for preventative treatment of migraines is adults.

Migraines are episodic events that include head pain, shoulder pain, nausea, dizziness, photophobia (aversion to light), and other symptoms. A number of prescription and over-the-counter medications are used to treat migraine attacks when they occur. Several medications are used off label for migraine prevention.

Ajovy and other CGRP antagonists (medications that counteract the effect of CGRP) are formally indicated for migraine prevention.

Off-Label Uses

While it is approved for migraines, Ajovy has also been used off-label for prevention of cluster headaches and vestibular headaches, which are often considered to be variants of migraine. 

Before Taking

Before starting Ajovy, sure to talk to your doctor and pharmacist about any health conditions that you have and list any medications that you use, including herbs and supplements.

Precautions and Contraindications

Ajovy is contraindicated if you have had an adverse reaction to fremanezumab-vfrm or to any of the other CGRP antagonists.

Be sure to tell your doctor if you are pregnant or breastfeeding. The safety of this medication has not been established during pregnancy and breastfeeding, so you and your doctor will have to carefully weigh the risks and benefits of taking it during this time.

Other CGRP Antagonists

Several monoclonal antibody CGRP antagonist medications are indicated for the preventive treatment of migraine in adults.

Aimovig (erenumab) and Emgality (galcanezumab) are approved products, and eptinezumab is an experimental product with the same mechanism of action. They are monoclonal antibodies that act against CGRP.

An increase in CGRP has been associated with migraine episodes. CGRP is believed to act as a vasodilator (expands blood vessels), and it may play a role in mediating pain. Medications that have this action, including Ajovy, counteract the effects of CGRP—and this is how they are believed to reduce migraine episodes.

A monoclonal antibody is a molecule that acts against a very specific target in the body. Because monoclonal antibodies like Ajovy are formulated to act against such a specific target, they are not believed to have a wide range of side effects.


This medication is used at a dose of 675 milligrams (mg) every three months or 225 mg every month. It comes in a 225-mg/1.5 milliliter (mL) solution in a single-dose prefilled syringe.

If you will be switching from one schedule to another (going from every month to every three months or from every three months to every month), the recommendation is to take the first dose of your new regimen on your next scheduled date, and then to continue future doses either three months or one month from that date.

If you miss your scheduled dose of Ajovy, the recommendation is that you take your next dose as soon as possible and continue your schedule one month or three months after your “make-up” injection.


There are no established recommendations for modifying the dose of Ajovy based on any medical conditions. 

How to Take

You can inject your own medication, or you can have a caregiver or family member inject it. In some instances, a health care provider can inject your medication for you.

Before using Ajovy at home, you (or your caregiver) will need to have instructions about how to administer a subcutaneous injection. A subcutaneous injection is placed underneath the skin, and the needle is angled sideways for a superficial injection, not placed straight down deep into the muscle.

Prior to injecting the medication, you need to properly clean the area on your skin where you will place the needle. It can be injected into your abdomen, thigh or upper arm. You can talk to your health care provider and confirm that you know how to select appropriate areas on your body so you will be able to do this at home.

If you are taking the 675 mg dose, you will need to use three pre-filled syringes containing 225 mg each. You can inject all three doses in the same body part (such as the right arm), but not in the exact same spot.

Be sure not to inject the medication into an area where you have a wound, rash, or bruise.

How to Store

According to the manufacturer, you should store Ajovy in a refrigerator at a temperature of 36 F to 46 F (2 C to 8 C) and it cannot be frozen. It should be kept in its original outer carton, which protects the medication from the light.

Before using the medication, you need to leave it at room temperature and out of the light for 30 minutes, and it cannot be used if it has been out of the refrigerator for longer than 24 hours. The manufacturer warns not to warm Ajovy in an oven, microwave, or with hot water.

Side Effects 

Ajovy can cause side effects. The most common side effect is a skin reaction at the site of the injection.

You can also experience systemic side effects throughout the body. Mild to moderate hypersensitivity (an allergic reaction) can occur within a few hours of the injection or may appear up to one month after the injection. Allergic reactions to Ajovy typically include itching, a rash, or hives. These reactions can be treated with oral (by mouth) or intravenous (IV) corticosteroids.

Rarely, this medication can cause swelling of the face, mouth, tongue, or throat—and it may cause trouble breathing. You need to contact your doctor immediately if you develop these reactions because you would need to have immediate treatment, which may include medical or mechanical support to help you breathe.

Warnings and Interactions

You should not use Ajovy if you are also using other CGRP inhibitors.

You may be able to use your other migraine medications in addition to Ajovy, but you should discuss your other migraine medications with your doctor before you start using Ajovy in case you would need to have any adjustments.

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