EMBARGOED FOR RELEASE UNTIL 4 PM ET, August 31, 2026
AAN and AHS issue updated guideline on migraine prevention medications for adults
Highlights:
- A guideline update by the American Academy of Neurology and American Headache Society has been published to help clinicians determine which medications may be most effective at preventing migraine in adults.
- Migraine is a chronic disease. Migraine attacks are often associated with nausea, sensitivity to light and sound and significant impairment in functioning, in addition to headache. Attacks can last from a few hours to several days.
- New developments in research since the publication of the previous guideline have expanded options for people with migraine. The guideline includes recommendations on newer preventive treatments.
- The guideline says preventive treatments should be offered to people who experience four or more migraine days per month or four or more moderate to severe headache days per month, or if migraine is affecting their ability to work or complete daily tasks.
- Watch the guideline press conference.
MINNEAPOLIS — To help clinicians determine
which medications may be most effective at preventing migraine in adults, the American Academy of Neurology (AAN) and American Headache Society (AHS) have issued a joint practice guideline
update with evidence-based recommendations,
published on August 31, 2026, in Neurology®, the medical
journal of the American Academy of
Neurology, and in Headache, the official
journal of the American Headache Society. This is an update to the AAN and AHS 2012
guideline. The guideline is endorsed by the American Academy of Family
Physicians.
Migraine is a
chronic brain disease that causes headache and many other neurological symptoms.
Migraine attacks can cause headaches, nausea, and sensitivity to light and
sound. Some people with migraine have additional symptoms such as dizziness,
visual changes or difficulty thinking. Attacks can last from a few hours to
several days. Serious symptoms may prevent people from working, socializing or
completing daily tasks. Acute
medications help stop headaches and other symptoms when they are happening.
Preventive medications are taken consistently, usually daily or monthly, to
prevent symptoms.
“There are a variety of effective preventive medications
that work in different ways, including newer classes of medications that have
been released in the past several years,” said guideline author Tamara
Pringsheim, MD, MSc, of the University of Calgary in Alberta, Canada, and a
Fellow of the American Academy of Neurology. “For people experiencing frequent
migraine attacks or attacks that affect the ability to function normally, this
guideline can help clinicians determine which preventive medications may be
able to help.”
The guideline update is based on a careful review of the available
evidence on the topic. For each studied medication, it includes the level of confidence in the evidence for effectiveness.
It includes recommendations for preventive medications for both chronic and
episodic migraine. People with chronic migraine have headaches
on 15 or more days a month which, on at least eight days a month, have the
features of migraine headache. People with episodic migraine have headaches on fewer days per
month.
New developments
in research since the publication of the previous guideline have expanded
options for people with migraine. The guideline includes recommendations
on newer preventive treatments in addition to older ones.
“The research shows many different types of medications may
be effective for preventing migraine attacks and reducing symptoms,” said
guideline author Rebecca C. Burch, MD, of the University of Vermont Larner
College of Medicine in Burlington, a Fellow of the American Headache Society
and a member of the American Academy of Neurology. “The guideline includes
recommendations for both previously established and newer medications. If one
type of medication is not working well, a different type may still be effective.
It is important for clinicians and patients to know that there are many
options.”
To reduce headache frequency, the guideline says preventive treatments should be offered to
people who experience four or more migraine days per month or four or more
moderate to severe headache days per month, or if migraine is affecting their
ability to work or complete daily tasks.
The guideline
states that clinicians should assess the impact of migraine on a person’s
quality of life when choosing a preventive medication, letting them know
there are a variety of effective medications that work in different ways. Some
types, like antidepressants or medications for lowering blood pressure, may
help treat both migraine and a second health condition. Others have been
designed specifically to treat migraine.
When working with
people to choose migraine preventives, the guideline states clinicians should
discuss the strength of the evidence, possible side effects, costs and the
types of medications. There are oral medications
that need to be taken every day or every other day and injectable medications
that are taken once a month or once every three months.
After someone
starts a new medication, clinicians should assess the effectiveness of the
treatment following the recommended timeframes provided in the guideline.
“Clinical practice guidelines are an important resource for
neurologists and other clinicians working to provide the best possible care for
people with neurological conditions,” said American Academy of Neurology
President Natalia S. Rost, MD, MPH, FAAN, FAHA, of Harvard Medical School and
Massachusetts General Hospital in Boston. “The American Academy of Neurology is
proud to partner with the American Headache Society on this guideline update to
help improve brain health for people living with migraine.”
“Migraine is the
most common reason for people to see a neurologist, and is encountered even
more commonly in primary care settings,” said American Headache Society
President Matthew S. Robbins, MD, of Weill Cornell Medicine and
NewYork-Presbyterian/Weill Cornell Medical Center in New York and a Fellow of the
American Headache Society and the American Academy of Neurology. “Newer treatment options have
revolutionized the care for millions of people in the U.S. and worldwide. The
American Headache Society is grateful to have partnered with the American
Academy of Neurology on this contemporary evidence based preventive treatment
guideline that promotes shared decision making between clinicians and their
patients.”
The guideline was funded by the American Academy of
Neurology.
Discover more about migraine at BrainHealth.com, a free public resource from the American Academy of Neurology. It offers a website, podcast, and books, connecting you with trusted information from the world’s leading experts in brain health. Follow BrainHealth.com on Facebook, X, and Instagram.
About the American Academy of Neurology
The American Academy of Neurology is the leading voice in
brain health. As the world’s largest association of neurologists and
neuroscience professionals with more than 44,000 members, the AAN provides
access to the latest news, science and research affecting neurology for
patients, caregivers, physicians and professionals alike. The AAN’s mission is
to enhance member career fulfillment and promote brain health for all. A
neurologist is a doctor who specializes in the diagnosis, care and treatment of
brain, spinal cord and nervous system diseases such as Alzheimer's disease,
stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache
and migraine.
Explore the latest in neurological disease and brain health,
from the minds at the AAN at AAN.com
or find us on Facebook,
X, Instagram, LinkedIn,
and YouTube.
About the American Headache Society
The mission of the American Headache Society is to improve
the care and lives of people living with headache disorders. The American
Headache Society (AHS) is a professional society of health care providers
dedicated to the study and treatment of headache and face pain. Educating
physicians, health professionals and the public, and encouraging scientific
research are the primary functions of the Society. For more information about the AHS,
visit americanheadachesociety.org or
follow us on social on Facebook, X,
Instagram, LinkedIn, and YouTube.