What's New in Migraine Prevention? Understanding the 2026 AAN/AHS Guidelines
Neurology: Disease Deep DiveSummary
The American Academy of Neurology (AAN) and the American Headache Society (AHS) have released significant updates to their guidelines on preventive migraine therapy, marking the first major revision since 2012. Dr. Andrew Blumenfeld from Cedars-Sinai Neurology highlights that the new guidelines emphasize shared decision-making between clinicians and patients, focusing on individual patient preferences regarding efficacy and tolerability of treatments. This approach aims to personalize care, allowing neurologists to tailor treatment plans based on patients' specific concerns and conditions.
The updated guidelines also stress the importance of early intervention to prevent the progression from episodic to chronic migraine. They recommend migraine-specific treatments as first-line options and provide a structured framework for clinicians to discuss treatment choices with patients. Dr. Blumenfeld notes that the guidelines include considerations for comorbid conditions, such as pregnancy and fibromyalgia, which can influence treatment decisions.
Looking ahead, Dr. Blumenfeld expresses excitement about the potential for combination therapies that target different mechanisms of action, which could enhance treatment efficacy. He emphasizes the need for ongoing updates to the guidelines to incorporate emerging research and therapies, particularly those targeting new pathways like PACAP, which may offer additional options for migraine management. The evolving landscape of migraine treatment aims to improve patient outcomes by focusing on both efficacy and tolerability in preventive care.
Show Notes
Andrew Blumenfeld, MD, Cedars-Sinai Neurology, Los Angeles, CA, discusses the updated American Academy of Neurology and American Headache Society guideline on preventive migraine therapy, including the growing emphasis on shared decision-making, the role of CGRP-targeted therapies, and balancing efficacy with tolerability. He also examines how clinicians can assess meaningful treatment response beyond migraine frequency and explores emerging approaches to prevention, including combination therapies and novel therapeutic targets.
Reference: Potrebic S, Tanveer S, Becker WJ, et al. Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society. Headache. 2026;66(9):2173-2184. doi:10.1111/head.70199
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