For the first time since 2012, the American Headache Society and the American Academy of Neurology have updated their guidelines for preventing migraine — catching up to a wave of new medicines that have transformed the field.
At least six new FDA-approved migraine drugs have arrived since the last guidance, and the update gives high marks to the newer CGRP-targeting therapies: atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality). Longtime standbys with more safety history remain recommended too — Botox (for chronic migraine), propranolol (episodic migraine) and the anti-seizure drug topiramate.
Who should consider prevention
The guidelines suggest preventive treatment for people with at least four migraine or severe-headache days a month, or whose migraines interfere with work or daily life. Migraine affects an estimated 15% of Americans, and disproportionately women. “There has been a wealth of new treatment available,” said co-author Rebecca Burch.
Why it matters
Guidelines shape what doctors prescribe and what insurers cover, so formally elevating CGRP drugs could widen access to therapies designed specifically for migraine (rather than repurposed from blood-pressure or epilepsy treatment). One note of nuance: candesartan, a cheap generic blood-pressure drug with supportive evidence, received an “insufficient evidence” rating — a reminder that guideline ratings hinge on the type of trial data available. This article is informational and not medical advice; discuss migraine prevention with your clinician.