US doctors expand migraine prevention guidelines
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In the United States, medical experts updated their recommendations for migraine prevention, broadening the number of patients who could benefit from preventative drugs.
A panel of specialists reviewed current research and revised guidelines last updated in 2012, publishing the changes in the journal Headache. The American Academy of Family Physicians also supports the new recommendations. Previously, preventative treatment was generally reserved for those experiencing headaches more than 15 days a month.
The updated guidelines now suggest clinicians offer preventative medications to patients with four or more moderate-to-severe headaches, or those with significant disability caused by migraines. Experts believe this change will help more people avoid chronic migraines, as research shows that the frequency of headaches predicts whether a condition will become chronic. The new guidelines highlight several pharmaceutical options, including CGRP-targeting drugs, atogepant, erenumab, fremanezumab, galcanezumab, and eptinezumab, as first-line treatments. Botox is also now recommended for chronic migraine sufferers.
Doctors acknowledge that finding the right medication can require trial and error, as individual responses vary, but emphasize that having more options increases the chance of success. The guidelines also detail potential side effects and harms associated with each treatment. After six months of preventative treatment, clinicians should discuss with patients the pros and cons of stopping medication, noting that migraines may return.
The experts hope these updated guidelines will improve care for the millions of people in the US and worldwide who experience migraines.
