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Fremanezumab (Ajovy®): A monthly or quarterly injectable treatment to prevent migraine
Fremanezumab (Ajovy®): A monthly or quarterly injectable treatment to prevent migraine
Fremanezumab (Ajovy®) is a CGRP monoclonal antibody used to prevent migraine.
It is given subcutaneously once every month using an auto-injector. It is the only CGRP monoclonal antibody that has flexible dosing either once a month or once every 3 months.
Looking for a detailed medication handout of Ajovy®? Explore our downloadable handouts created by the specialists at the Ottawa Headache Centre.
How to access fremanezumab (Ajovy®) in Ottawa
How to access fremanezumab (Ajovy®) in Ottawa
Who may benefit from fremanezumab (Ajovy®)?
Who may benefit from fremanezumab (Ajovy®)?
Fremanezumab (Ajovy®) is used for the prevention of episodic or chronic migraine. It is the only CGRP monoclonal antibody approved for both pediatrics (ages 6-17 years) and adults in Canada.
Fremanezumab (Ajovy®) is administered with an auto-injector similar to an epinephrine-pen. It is self-injected once a month or once every 3 months.
We consider fremanezumab (Ajovy®) when:
Patients continue to have frequent migraine attacks after trying two oral preventives
Pregnancy is not foreseeable for at least 6 months
There is a preference for infrequent dosing rather than taking a medication every day
There is a preference for a self-administered medication at home rather than an intravenous treatment
How do you access fremanezumab (Ajovy®) in Ottawa?
How do you access fremanezumab (Ajovy®) in Ottawa?
In Ontario, coverage for fremanezumab (Ajovy®) often requires:
A diagnosis of episodic or chronic migraine
Documentation of migraine frequency
Trials of at least two oral preventive medications at therapeutic doses (usually for ~3 months each, depending on insurer)
People without private insurance may be eligible to have the cost of fremanezumab (Ajovy®) reimbursed through an application to the Exceptional Access Program (this can be done by any doctor).
At the Ottawa Headache Centre we will:
Confirm your diagnosis and migraine burden
Determine whether fremanezumab (Ajovy®) is an appropriate option, and offer alternatives
Discuss the evidence backing fremanezumab (Ajovy®), its benefits, as well as side-effects
Assist with any insurance forms
Complete the prior authorization process that is needed
Next steps to get started on fremanezumab (Ajovy®) in Ottawa
Next steps to get started on fremanezumab (Ajovy®) in Ottawa
If you feel like you are getting nowhere with your migraine preventives, ask your doctor for a referral to the Ottawa Headache Centre and we will explore migraine-specific preventive options with you.
How does fremanezumab (Ajovy®) prevent migraine
How does fremanezumab (Ajovy®) prevent migraine
Fremanezumab (Ajovy®) binds to CGRP in the bloodstream, preventing it from activating migraine pain pathways.
By reducing CGRP activity, fremanezumab (Ajovy®):
Lowers the likelihood that a migraine attack will occur.
Decreases the severity and duration of migraine attacks.
Makes migraine attacks more susceptible to acute medications (i.e., easier to treat).
Next steps
Next steps
Fremanezumab (Ajovy®) is one of the most commonly prescribed CGRP antagonists. Determining whether it is the right migraine-specific preventive for you depends on your diagnosis, migraine pattern, prior treatment history, preferences, and lifestyle values.
If you are considering Ajovy® (or have been referred), our consultation helps:
confirm whether fremanezumab (Ajovy®) fits your migraine profile
set realistic timelines for judging response
and place it into a broader, individualized care plan (including acute and non-medication strategies).
Ask your doctor for a referral to the Ottawa Headache Centre if you want to learn more about your migraine-specific preventive options.
Common questions about fremanezumab (Ajovy®)
Common questions about fremanezumab (Ajovy®)
What are the side effects of fremanezumab (Ajovy®)?
What are the side effects of fremanezumab (Ajovy®)?
Fremanezumab (Ajovy®) is generally very well tolerated.
Possible side effects:
Constipation
Injection-site reactions (redness, soreness)
Muscle or joint aches
Fatigue (uncommon)
Urinary tract infections or nasopharyngitis (rare)
Serious allergic reactions are rare.
Does fremanezumab (Ajovy®) affect the immune system?
Does fremanezumab (Ajovy®) affect the immune system?
No.
Fremanezumab (Ajovy®):
Does not suppress the immune system
Does not increase infection risk
Is not considered an immunosuppressive therapy
Can fremanezumab (Ajovy®) be used during pregnancy?
Can fremanezumab (Ajovy®) be used during pregnancy?
CGRP monoclonal antibodies including fremanezumab (Ajovy®) are not recommended during pregnancy due to limited safety data.
If pregnancy is planned:
These medications should be stopped at least 6 months before pregnancy
This allows time for the medication to fully clear from the body.
If you are pregnant or planning pregnancy, we will help you find alternative migraine strategies.
Can fremanezumab (Ajovy®) be used during breastfeeding or lactation?
Can fremanezumab (Ajovy®) be used during breastfeeding or lactation?
Data on breastfeeding are limited but growing, and expert consensus is that CGRP monoclonal antibodies' expression in breast-milk is low, the amount of drug an infant may consume and ultimately absorb is trivial. Decisions are individualized based on:
Migraine severity
Available alternatives
Patient preferences
We help guide these discussions using the best available evidence.
Is fremanezumab (Ajovy®) covered for migraine in Ontario?
Is fremanezumab (Ajovy®) covered for migraine in Ontario?
In Ontario, coverage for fremanezumab (Ajovy®) often requires:
A diagnosis of episodic or chronic migraine
Documentation of migraine frequency
Trials of at least two oral preventive medications at therapeutic doses (usually for ~3 months each, depending on insurer)
People without private insurance may be eligible to have the cost of fremanezumab (Ajovy®) reimbursed through an application to the Exceptional Access Program.
We assist with:
Insurance forms
Prior authorization
Can fremanezumab (Ajovy®) be combined with other treatments?
Can fremanezumab (Ajovy®) be combined with other treatments?
From a medical perspective, fremanezumab (Ajovy®) can be used:
Alone
Alongside other oral preventive medications
Concurrently with Botox® for chronic migraine, although insurers will typically not cover both
Insurance plans may restrict coverage of combination advanced therapies.
Can gepants be combined with fremanezumab (Ajovy®)?
Can gepants be combined with fremanezumab (Ajovy®)?
From a medical perspective, it is safe to combine fremanezumab (Ajovy®) and gepants although the combination may increase the risk of constipation.
Insurance plans may restrict coverage of combining a preventive gepant - like atogepant (Qulipta ®) and CGRP monoclonal antibodies..
What happens if fremanezumab (Ajovy®) works?
What happens if fremanezumab (Ajovy®) works?
If fremanezumab (Ajovy®) is effective:
Treatment is continued
There is no monitoring required
Many patients can transition prescription renewal to their family physician
Treatment may be discontinued 1-2 years later to revaluate whether it needs to be continued
If I did not respond to one CGRP antagonist, does that mean that I won't respond to any?
If I did not respond to one CGRP antagonist, does that mean that I won't respond to any?
No.
For many people it takes a few trials to find the most effective migraine preventive, and some people who have not responded to one CGRP antagonist respond to a different one. It is not uncommon to cycle through different treatment options until we find the one that is right for you.
Disclaimer
Disclaimer
This material is provided for educational purposes and does not replace independent clinical judgment or institutional protocols. Management decisions remain the responsibility of the treating clinician.
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