onabotulinumtoxinA + fremanezumab

A combination therapy using onabotulinumtoxinA (Botox) and fremanezumab (Ajovy) for the prevention of chronic migraine. This approach combines two medications with different mechanisms of action targeting different aspects of migraine pathophysiology. OnabotulinumtoxinA is a purified form of botulinum toxin type A administered via injections across the head and neck, primarily blocking acetylcholine release and inhibiting CGRP release from C fibers. Fremanezumab is a monoclonal antibody administered subcutaneously, primarily targeting CGRP on A-delta fibers. Real-world evidence suggests that this combination may provide additional benefits for patients with chronic migraine who have an inadequate response to Botox alone, including significant reductions in monthly headache days compared to Botox alone or other CGRP monoclonal antibodies in combination with Botox. The combination appears to be well-tolerated.

Brand names

Botox + Ajovy

Other names

Botox + fremanezumabonabotulinumtoxinA + fremanezumab-vfrm