New AAN/AHS Migraine Prevention Guideline Updates Treatment Recommendations
KEY TAKEAWAYS
- The AAN and AHS have issued an updated evidence-based framework for selecting preventive migraine treatment based on individual patient needs.
- Preventive treatment should be offered to adults with at least 4 migraine days or 4 moderate-to-severe headache days per month, or when migraine interferes with daily functioning.
- The guidance incorporates newer preventive therapies and emphasizes shared decision-making around evidence, adverse effects, cost, comorbidities, and dosing.
The American Academy of Neurology (AAN) and American Headache Society (AHS) have issued an updated guideline for pharmacologic migraine prevention in adults, incorporating established medications and newer preventive treatments introduced since the organizations’ previous guidance published in 2012. The guideline, published in both Neurology and Headache, is endorsed by the American Academy of Family Physicians.
The update is based on a review of available evidence and addresses preventive treatment for episodic and chronic migraine, with levels of confidence assigned to evidence supporting individual medications. Chronic migraine is defined as headache on at least 15 days per month, with migraine features on at least 8 days; episodic migraine occurs on fewer days per month.
What the Updated Migraine Guideline Recommends
- Offer preventive treatment to adults with at least 4 migraine days or 4 moderate-to-severe headache days per month, or when migraine interferes with work or daily activities.
- Consider migraine-related quality of life when selecting treatment.
- Discuss evidence, potential adverse effects, cost, medication type, and dosing schedule with patients.
- Reassess treatment effectiveness according to the timeframes specified in the guideline.
The recommendations encompass established and newer therapies. Some options, including certain antidepressants and blood pressure-lowering medications, may address migraine alongside another health condition, whereas others were developed specifically for migraine. Treatment options range from oral medications taken daily or every other day to injectable therapies administered monthly or every 3 months.
What This Means for Neurologists
For neurologists, the update provides a current framework for navigating a growing range of migraine preventive therapies. The decision to offer prevention is not based on headache frequency alone; migraine-related impairment should also factor into treatment decisions. The guideline also reinforces an individualized approach to selecting therapy, with efficacy evidence considered alongside comorbidities, adverse effects, cost, dosing, and patient preferences. If one preventive strategy does not work well, other options with different mechanisms remain available.
Source
American Academy of Neurology and American Headache Society. AAN and AHS issue updated guideline on migraine prevention medications for adults. Press release. August 31, 2026.