Overview
- A joint practice guideline from the American Academy of Neurology and the American Headache Society was published on Aug. 31, 2026 and updates the 2012 guidance with a systematic review of 217 trials through mid-June 2024.
- The guideline recommends offering preventive treatment to adults with four or more migraine days per month or four or more moderate-to-severe headache days per month or when migraine limits daily function.
- Panel ratings give high-confidence support to specific CGRP-targeted monoclonal antibodies—galcanezumab and erenumab for episodic migraine, and fremanezumab and galcanezumab plus onabotulinumtoxinA for chronic migraine—while other drugs receive lower or moderate confidence grades.
- Authors emphasize shared decision-making that weighs effectiveness, side effects, long-term safety, pregnancy considerations, and cost, and they advise clinicians to assess response within recommended 8–12 week timeframes.
- Experts warn the guideline’s layered criteria and the mid-June 2024 evidence cutoff could complicate primary-care uptake and give payers grounds for denials, and recent trials published after the cutoff—most notably a large candesartan study—were not included and may change future recommendations.