A New Era in Migraine Treatment in the USA: The Guideline Has Changed
The updated migraine guideline in the USA recommends that more adults who experience at least four days of attacks per month be considered for preventive treatment.
In the United States, a significant shift was made in the treatment approach aimed at preventing migraine. The updated guideline, revised by the American Academy of Neurology and the American Headache Society, recommends evaluating more migraine patients for preventive medication. The new approach particularly covers adults who experience four or more migraine days per month.
Four-Day Monthly Critical Threshold
According to the new guideline, preventive treatment should be offered to patients who have at least four migraine days per month. This approach foresees evaluating treatment options not only for those with very frequent or chronic migraine, but also for patients who experience fewer attacks yet whose quality of life is affected.
Goal: Reduce Attacks
The primary aim of preventive migraine treatment is to reduce the frequency of headaches and migraine attacks and the disease burden. The new guideline advises doctors to base treatment decisions on the patient's migraine days, attack severity, and impact on daily life.
CGRP Drugs Take Center Stage
Another important dimension of the shift in migraine treatment is represented by drugs targeting CGRP. The American Headache Society supports considering these treatments among first‑line options alongside some drugs previously used for migraine prevention. Among these drugs are monoclonal antibodies targeting CGRP and orally administered gepants.
Old Approach is Changing
Previously, there was an approach that other preventive drugs should be tried before moving to CGRP‑targeted therapies. The 2024 update published by the AHS stated that CGRP‑targeted treatments can be considered among first‑line options without waiting for patients to fail other drug classes.
Treatment Decision Will Be Made Based on the Patient
The guideline does not mean that preventive medication should be started automatically for every migraine patient. The treatment decision is made taking into account factors such as the number of migraine days, attack severity, the disease's impact on daily life, the characteristics of the medications used, and the patient's treatment preferences.
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