Minneapolis – September 04, 2026 -- The American Academy of Neurology (AAN) and American Headache Society (AHS) have issued a joint update to their 2012 clinical practice guideline on migraine prevention medications for adults, published simultaneously in Neurology and Headache journals on August 31, 2026.
Guideline sets clear treatment threshold for clinicians
The update recommends preventive treatment for patients experiencing four or more migraine days per month, four or more moderate-to-severe headache days per month, or migraine that impairs their ability to work or complete daily tasks. It distinguishes between chronic migraine, defined as 15 or more headache days a month with at least eight showing migraine features, and episodic migraine, which occurs on fewer days per month.
Newer drug classes join guideline for first time since 2012
The update incorporates preventive medication classes developed since the last review, expanding clinician options beyond older established drugs such as antidepressants and blood-pressure medications repurposed for migraine treatment. Guideline author Tamara Pringsheim, MD, of the University of Calgary, said the newer medication classes released over the past several years work through different mechanisms, giving clinicians more tools for patients with frequent or disabling attacks.
Guideline covers oral and injectable dosing regimens
Recommended preventive options span daily or every-other-day oral medications and injectable treatments administered monthly or once every three months. Rebecca C. Burch, MD, of the University of Vermont Larner College of Medicine, said that when one medication class fails to work, clinicians and patients have multiple alternative options to try.
American Academy of Family Physicians endorses the update
The guideline instructs clinicians to weigh evidence strength, side-effect profiles, cost and drug type when selecting a preventive with patients, and to evaluate treatment effectiveness using timeframes specified in the document. It carries formal endorsement from the American Academy of Family Physicians and was funded by the AAN.
AAN President Natalia S. Rost, MD, of Harvard Medical School, called the update an important resource for neurologists managing brain health outcomes. AHS President Matthew S. Robbins, MD, of Weill Cornell Medicine, noted migraine is the most common reason patients see a neurologist and is frequently managed in primary care, adding that newer treatment options have changed care for millions of patients in the U.S. and worldwide.