Updated migraine guidelines spotlight dozens of new preventive therapies for patients

In a first comprehensive revision since 2012, the American Headache Society and the American Academy of Neurology issued new recommendations that incorporate a half dozen FDA-approved preventive medicines, most of which block the CGRP pathway. The guidance urges doctors to offer preventive treatment to patients with at least four migraine days each month or whose headaches limit productivity. It covers both episodic and chronic migraine, defines chronic migraine as fifteen or more headache days per month with migraine features, and rates newer agents like atogepant, eptinezumab, erenumab, fremanezumab and galcanezumab highly for efficacy and tolerability.

Older therapies such as Botox, propranolol and topiramate are retained for their longer safety record. The document also flags complexities for primary-care providers, potential conflicts with obstetric guidelines, and the risk that layered eligibility criteria may impede insurance coverage.