US Guidelines Broaden Migraine Prevention to More Patients
US neurologists have updated the 2012 AAN/AHS migraine guidelines, recommending preventive treatment for patients with four or more moderate-to-severe headaches per month or substantial migraine-related disability. The update endorses newer CGRP-targeting drugs (atogepant, erenumab, fremanezumab, galcanezumab, eptinezumab) as first-line options and adds Botox for chronic migraine, while recognizing additional options like propranolol, topiramate, valproate, and amitriptyline in specific cases. Because responses vary and side effects occur, multiple treatments may be tried. The guidelines are non-binding but intended as a resource to improve access to effective prevention; after about six months of preventive therapy, clinicians should discuss tapering and potential rebound risks.
