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.
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 Brain & Life® , from the American Academy of Neurology. This resource offers a website, podcast, and books that connect patients, caregivers and anyone interested in brain health with the most trusted information, straight from the world's leading experts in brain health. Follow Brain & Life 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.
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