No new drug approvals or safety communications affecting neurology today. The substantive guidance is a new practice guideline from the American Academy of Neurology Guidelines Subcommittee and the American Headache Society on pharmacologic migraine prevention in adults, following a systematic review of studies published through June 2024 and released alongside it.
The guideline addresses two questions clinicians actually ask — when it is appropriate to start a preventive, and which one to start — and then works through the situations where that choice changes: fibromyalgia, obesity, hypertension, older adults, pregnancy and lactation, sex-related considerations, and patients with medication overuse. It also covers how to assess whether a preventive is working, how to handle adverse effects, and when to stop.
That last part is the most neglected in practice. Preventives are frequently started and rarely reviewed, and a guideline that sets out discontinuation criteria is doing something more useful than ranking agents.
- No new approvals or safety communications for neurology today
- Covers when to start and what to start, not only comparative efficacy
- Specific guidance for obesity, hypertension, pregnancy, lactation and older adults
- Includes medication-overuse headache, where preventive choice is most contested
- Sets out how to assess response and when to discontinue — the commonly skipped step
The statistics, in plain English
A practice guideline reports no effect size of its own. Its weight comes from the systematic review beneath it and the transparency of how recommendations were derived — here, structured rationales linking each recommendation to the evidence, which is what lets a reader judge a recommendation they disagree with.
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