MINNEAPOLIS, Minnesota, Aug. 31, 2026
The American Academy of Neurology (AAN) and the American Headache Society (AHS) have issued an updated evidence-based clinical practice guideline on migraine prevention medications for adults, providing clinicians with recommendations on established and newer treatment options. Published in Neurology and Headache, the update replaces the organizations’ 2012 guidance and reflects advances in migraine prevention research over the past decade. The guideline is designed to help healthcare professionals select preventive therapies based on treatment effectiveness, evidence strength, potential side effects, cost and individual patient needs.
AAN and AHS Expand Migraine Prevention Guidance
The updated guideline recognizes that advances in research have significantly expanded the range of preventive treatment options for migraine. The recommendations address both episodic and chronic migraine and include newer preventive therapies alongside previously established medications. According to the AAN and AHS, the evidence review assessed available research and provided levels of confidence regarding the effectiveness of individual medications, giving clinicians a more current framework for treatment decisions. Migraine is described as a chronic brain disease that can cause headache and other neurological symptoms, including nausea, sensitivity to light and sound, dizziness, visual changes and difficulty thinking. Attacks may last from several hours to multiple days and can substantially interfere with work, social activities and everyday functioning. Preventive medications are used regularly to reduce the frequency and severity of these attacks rather than treating symptoms only after they begin. The updated guidance states that preventive treatment should be offered to people experiencing four or more migraine days per month, four or more moderate-to-severe headache days per month, or migraine that significantly affects their ability to work or perform daily activities. This threshold is intended to help clinicians identify patients who may benefit from preventive therapy rather than relying exclusively on acute treatment when attacks occur.
Newer Treatments Expand Therapeutic Options
A key feature of the update is its recognition of newer migraine-preventive medications that have become available since the previous guideline. The AAN and AHS noted that different medicines can work through different mechanisms, meaning patients who do not respond adequately to one treatment may still benefit from another preventive approach. The guideline encourages clinicians to consider the individual impact of migraine and the patient’s quality of life when selecting a preventive therapy. Some medicines used for migraine prevention may also address other medical conditions. For example, certain antidepressants or blood-pressure-lowering medicines can potentially provide benefits beyond migraine prevention, while other therapies have been developed specifically for migraine. Treatment choices should also take into account the strength of available evidence, potential adverse effects, cost and administration requirements. Preventive options can include oral medicines taken daily or every other day as well as injectable treatments administered monthly or once every three months. The guideline also recommends evaluating treatment effectiveness after therapy begins according to the timeframes specified in the recommendations.
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Updated Guidance Supports Shared Decisions
The AAN and AHS said the guideline is intended to support shared decision-making between clinicians and patients. Rather than recommending a single universal preventive treatment, the updated recommendations recognize that migraine management should account for differences in disease frequency, symptom burden, treatment preferences, tolerability and access. The update also reflects the growing importance of evidence-based clinical guidelines in neurological care. AAN President Natalia S. Rost, MD, MPH, FAAN, FAHA, said the organization was pleased to partner with AHS on the update to help improve brain health for people living with migraine. AHS President Matthew S. Robbins, MD, emphasized that newer treatment options have changed migraine care and that the contemporary guideline provides an evidence-based framework for preventive treatment. The guideline was funded by the American Academy of Neurology and endorsed by the American Academy of Family Physicians. Its publication provides neurologists and other healthcare professionals with updated evidence to support individualized migraine prevention strategies and reflects the continued evolution of treatment options for one of the most commonly encountered neurological conditions.
Source: American Academy of Neurology, American Headache Society press release
