Ajovy (Fremanezumab) and Anxiety in Patients with Baseline Anxiety
Fremanezumab does not trigger or worsen anxiety in patients with baseline anxiety and may actually improve anxiety symptoms in chronic migraine patients with psychiatric comorbidities.
Evidence from Clinical Studies
The most robust evidence comes from a 2023 real-world study specifically examining fremanezumab's effects on psychiatric comorbidities, including anxiety, in difficult-to-treat chronic migraine patients 1. This study is particularly relevant because:
- 43.1% of patients with baseline psychiatric comorbidities (primarily anxiety and/or depression) experienced reduction in severity or complete resolution of these symptoms after fremanezumab treatment 1
- Patients with and without psychiatric comorbidities achieved comparable efficacy rates (58.5% vs 66.6% achieving ≥50% reduction in monthly headache days) 1
- Both groups experienced significant improvements in disability and quality of life outcomes at comparable rates 1
Mechanism and Safety Profile
Fremanezumab targets the CGRP peptide itself, not central nervous system pathways that would typically affect anxiety 2, 3. The 2024 VA/DoD Clinical Practice Guideline for Headache Management gives fremanezumab a "strong for" recommendation for episodic or chronic migraine prevention, with no mention of anxiety as a contraindication or adverse effect 4.
Additional Supporting Evidence
A 2026 study examining sleep quality in chronic migraine patients treated with fremanezumab found:
- Significant improvements in anxiety scores (measured by HAM-A) during 6 months of treatment 5
- Patients with higher baseline anxiety had higher sleep disturbance, but fremanezumab improved both parameters 5
Anxiety About Treatment Itself
One study specifically addressed anticipatory anxiety about medication wearing off, noting that patients should be informed upfront that no wearing-off effect occurs with fremanezumab, as anxiety about end-of-month attacks can itself trigger migraine 6.
Clinical Implications
For patients with baseline anxiety considering fremanezumab:
- No dose adjustment or special monitoring for anxiety is required 1
- The medication may provide dual benefit by reducing both migraine frequency and psychiatric symptom burden 1
- Common adverse effects are injection-site reactions and upper respiratory infections, not psychiatric symptoms 2, 7
- Unlike some traditional migraine preventives (beta-blockers, topiramate), fremanezumab has no contraindications related to psychiatric conditions 2
Quality of Life Benefits
The FOCUS study demonstrated progressive improvements over 6 months in: