The American Academy of Neurology and the American Headache Society have published an updated practice guideline on pharmacological migraine prevention in adults, in Neurology in August. The systematic review behind it covers studies to June 2024 and appears in a companion paper.
The guideline addresses when to start a preventive, how to choose among them, and how to tailor choice for patients with fibromyalgia, obesity or hypertension, older adults, pregnancy and lactation, sex-related factors and medication overuse. It also covers how to judge whether a preventive is working, how to handle adverse effects and when to stop.
The abstract does not give the individual recommendations or their strength. What it does show is a move towards choosing a preventive for the patient in front of you — comorbidity, pregnancy plans, age — rather than a single ladder. Read the full recommendations before revising a headache clinic protocol.
- Record monthly headache days and acute-medication days before and after starting a preventive.
- Match the preventive to comorbidity: blood pressure, weight, mood, sleep and pregnancy plans.
- Address medication overuse as part of prevention, not separately.
- Plan a review point and a stopping rule when you start.
Why it matters
Migraine prevention is now framed as tailored choice across comorbidities rather than a fixed sequence.
Don't overread it
The abstract lists the questions covered, not the recommendations or their evidence grades.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free