Guideline Update To Help Clinicians Determine Most Effective Medications For Preventing Migraine In Adults

The American Headache Society (AHS) and American Academy of Neurology (AAN) recently published an updated joint practice guideline with evidence-based recommendations in Headache, the official journal of the American Headache Society. This is an update to the AHS and AAN 2012 guideline and is endorsed by the American Academy of Family Physicians.

This recent update is grounded in the thorough examination of available evidence on the topic and includes the level of confidence in the evidence for effectiveness of each medication reviewed. The guideline provides recommendations for both episodic migraine — headaches occurring less than 15 days per month — and chronic migraine, headaches that occur 15+ days per month with at least 8 days featuring migraine.

Guideline co-author Rebecca C. Burch, MD, says two of the biggest differences in the updated guideline are the wealth of new prevention treatments, specifically the CGRP-targeted therapies, and the synthesis of both new and older treatments in one place. “The guideline includes recommendations for both previously established and newer medications,” writes Dr. Burch. “If one type of medication is not working well, a different type may still be effective. It is important for clinicians and patients to know that there are many options.” Another notable difference, according to Dr. Burch, is the inclusion of specific recommendations driven by patient priorities.

The guideline flexibly advises on the use of preventive treatment to reduce headache frequency in individuals experiencing the following: four or more migraine days per month, four or more moderate to severe headache days per month, or migraine that impacts work and daily tasks.

When choosing a preventive medication, the guideline encourages clinicians to evaluate the effect of migraine on their patient’s quality of life, inform them of the types of medications and how they work, and discuss the strength of the evidence, possible side effects, and how accessible they may be. Some medications are designed to specifically treat migraine, while others, like antidepressants, treat another condition but may also help treat migraine. There are preventive medications that can be administered orally (daily or alternating days) or injected (monthly or quarterly). These considerations can influence joint treatment choices by clinicians and patients.

Lastly, the guideline suggests clinicians assess treatment effectiveness following recommended timelines at regular intervals.

AHS President Matthew S. Robbins, MD, FAHS, shares his gratitude for the continued development of this guideline. “Migraine is the most common reason for people to see a neurologist, and is encountered even more commonly in primary care settings,” writes Dr. Robbins. “Newer treatment options have revolutionized the care for millions of people in the U.S. and worldwide. The American Headache Society is grateful to have partnered with the American Academy of Neurology on this contemporary evidence-based preventive treatment guideline that promotes shared decision-making between clinicians and their patients.”

Access the current list of AHS guidelines, position statements, evidence assessments, and consensus opinions published in the journal Headache®.

Hear more from Dr. Burch in the AAN 2026 Press Conference: Pharmacologic Treatment for Migraine Prevention in Adults video, and read the full press release.