The American Academy of Neurology (AAN) and American Headache Society (AHS) have issued an updated joint practice guideline to help clinicians select preventive medications for adults with migraine. The evidence-based guidance updates recommendations published in 2012 and covers both established treatments and newer preventive therapies.

The guideline recommends offering preventive treatment to people experiencing four or more migraine days per month, or four or more moderate to severe headache days per month. Prevention should also be considered when migraine substantially affects a person’s ability to work, carry out daily activities or otherwise function normally.

Migraine is a chronic neurological disease that can cause headache, nausea, sensitivity to light and sound, dizziness, visual symptoms and cognitive difficulties. Attacks may last from several hours to several days. The guideline addresses both episodic and chronic migraine, with chronic migraine defined by headache on at least 15 days per month, including at least eight days with migraine features.

The update reflects the expansion of preventive treatment options since the previous AAN and AHS guideline. Clinicians are advised to consider the impact of migraine on quality of life and discuss the strength of evidence for individual treatments, potential adverse effects, costs and different routes and frequencies of administration.

Treatment choice should also take account of coexisting conditions. Some established preventive medicines, including certain antidepressants and blood pressure treatments, may address migraine alongside another condition, while newer therapies have been developed specifically for migraine.

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The guideline emphasises shared decision-making and notes that failure to respond adequately to one preventive medication does not mean another approach will be ineffective. Clinicians should assess treatment effectiveness after initiation according to the recommended timeframes.

The joint guideline is due to be published in Neurology and Headache and has been endorsed by the American Academy of Family Physicians. It was funded by the AAN.

This news item has been summarised using AI and checked by humans before publication.

Sources

American Academy of Neurology / Newswise

American Headache Society clinical practice guidelines

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