WASHINGTON (dpa-AFX) - The American Academy of Neurology (AAN) and the American Headache Society (AHS) have released updated guidelines for preventing migraine based on scientific evidence.
The updated guidelines, published in Neurology and Headache, include newer medicines that were not available when the earlier guidelines were published. They help doctors choose the most suitable treatment based on how well it works, possible side effects, cost, and the patient's other health conditions.
The guidelines discuss how preventive medicines are different from medicines used to treat a migraine attack after it starts. Instead of being taken only when symptoms appear, preventive medicines are taken regularly to reduce how often migraines occur or how severe they are.
The new guidelines recommend atogepant, erenumab, fremanezumab, galcanezumab, and eptinezumab as first-choice medicines for preventing migraine. These medicines are given in different ways. Atogepant is taken as a daily tablet, eptinezumab is given through an IV infusion, and the others are given as injections. Clinical trials have shown strong evidence that these medicines can help reduce migraine attacks.
For people with episodic migraine, meaning migraine occurring on fewer than 15 days a month, the treatments with the strongest evidence of effectiveness include atogepant, eptinezumab, erenumab, fremanezumab, galcanezumab, propranolol, topiramate, and valproate. For people with chronic migraine, meaning migraine occurring on 15 or more days a month, most of the same medicines are recommended, except propranolol. Botox is also an option for chronic migraine.
The guidelines also discuss the possible side effects and potential long-term or unknown risks of these treatments. For people who have both fibromyalgia and migraine, the new guidelines recommend amitriptyline as a preventive treatment.
After about six months of preventive treatment, the guidelines recommend that doctors should discuss with patients whether they should gradually reduce or stop the medicine. They should consider both the possible benefits and risks. There is a possibility that migraines may become more frequent after stopping preventive treatment, although there is limited evidence about how often this happens.
Overall, the updated guidelines give doctors more options for preventing migraine and suggest that more people with frequent or severe migraines may benefit from preventive treatment.
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