American neurological societies issue new migraine treatment guidelines

The American Academy of Neurology and the American Headache Society have released the first updated clinical guidelines for migraine pharmacological prevention in 14 years. Based on a systematic review of 217 randomized controlled studies, the new recommendations evaluate both traditional medications and modern CGRP (calcitonin gene-related peptide) inhibitors.

For episodic migraine, galcanezumab and erenumab have the highest level of evidence for reducing headache frequency. Other treatments, including atogepant, eptinezumab, fremanezumab, propranolol, topiramate, and valproate, are categorized as having moderate evidence. For chronic migraine—defined as headaches occurring more than 15 days per month—fremanezumab, galcanezumab, and onabotulinumtoxinA are recommended.

Experts emphasize that the choice of therapy should be individualized, considering the patient's specific type of migraine, comorbid conditions, and potential side effects. While newer CGRP therapies represent a significant advancement, clinicians note that older medications remain important alternatives, and a lower level of scientific evidence does not necessarily mean a drug is ineffective for all patients.