New Migraine Prevention Guideline Updates: Recommended Medications for Adults
What if preventing migraine could become more personalized, with multiple medication options tailored to each patient’s needs?
The American Academy of Neurology (AAN) and American Headache Society (AHS) have issued an updated joint guideline to help clinicians choose effective preventive medications for adults with migraine. Published August 31, 2026, in Neurology and Headache, the update replaces the organisations’ 2012 recommendations and is endorsed by the American Academy of Family Physicians.
Migraine is a chronic neurological disease that can cause headache, nausea, sensitivity to light and sound, dizziness, visual disturbances and difficulty thinking. Attacks may last several hours to days and can significantly interfere with work and daily activities.
The updated guideline reviews evidence for preventive treatments in both episodic and chronic migraine, including newer therapies developed since the previous recommendations. Chronic migraine involves headache on at least 15 days per month, with migraine features on at least eight days.
According to the guideline, preventive treatment should be offered to people experiencing four or more migraine days per month, four or more moderate-to-severe headache days, or migraine that substantially affects their ability to function.
The recommendations emphasise shared decision-making. Clinicians should consider the impact of migraine on quality of life alongside the strength of evidence, potential side effects, cost and dosing preferences. Options include oral medications taken daily or every other day, as well as injectable treatments administered monthly or every three months.
Some established medicines, including certain antidepressants and blood-pressure medications, may provide additional benefits for people with other health conditions, while newer treatments are specifically designed for migraine prevention.
The guideline also recommends reassessing treatment effectiveness after starting a preventive medication. If one therapy is ineffective or poorly tolerated, clinicians can consider alternatives, reflecting the expanding range of evidence-based options available for migraine prevention.
REFERENCE: Potrebic, S., et al. (2026). Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations. Neurology. DOI: 10.1212/wnl.0000000000214881
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