To help clinicians determine which medications may be most effective in preventing migraine in adults, the American Academy of Neurology (AAN) and the American Headache Society (AHS) have issued a joint clinical practice guideline update with evidence-based recommendations, published on August 12, 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.
What Is Migraine?
Migraine is a chronic brain disease that causes headache and many other neurological symptoms. In addition to headaches, migraine attacks can cause 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. Preventive medications are taken consistently, usually daily or monthly, to prevent symptoms. Acute medications help stop headaches and other symptoms when they are happening.
“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.” — Tamara Pringsheim, M.D., M.Sc.
“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, M.D., M.Sc., of the University of Calgary in Alberta, Canada, 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, as well as recommendations for preventive medications for both chronic and episodic migraine. People with chronic migraine have headaches on 15 or more days per month which, on at least 8 days per month, have the features of migraine headache. People with episodic migraine have headaches on fewer days per month.
New Research Developments, Expanded Treatment Options
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, M.D., associate professor of neurological sciences at the University of Vermont Robert Larner, M.D. 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 suggests offering preventive treatments 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.
“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.” — Rebecca C. Burch, M.D.
The guideline advises clinicians to 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.
Considerations for Clinicians and Patients
When working with people to choose migraine preventives, the guideline states that 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.
The guideline update was supported by funds from the American Academy of Neurology.