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For the first time since 2012, two major medical groups have updated their recommendations on medicines used to prevent migraine attacks. The new guidance from the American Academy of Neurology (AAN) and American Headache Society (AHS) reflects a major change in migraine care: There are now more preventive treatments to choose from, including newer medicines designed specifically to target migraine.
That matters if migraine regularly disrupts your life. The guideline says doctors should offer preventive treatment to adults who have any of the following:
The updated recommendations also stress that choosing a preventive treatment should be a shared decision. There’s no single option that has been shown to work best for everyone.
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The previous AAN and AHS guideline was published in 2012. Since then, several new migraine-specific preventive treatments have become available. These include medicines that block calcitonin gene-related peptide (CGRP), a protein involved in migraine.
The new guideline includes these newer treatments alongside medications that have been used for migraine prevention for many years.
It also encourages doctors and people with migraine to consider more than effectiveness alone. Factors that may affect your treatment choices include:
Researchers reviewed evidence on a wide range of preventive medications and rated how confident they were in the findings. The strength of the evidence varied by the treatment, migraine type, and outcome measured.
Based on a systematic review, the guideline highlights the following treatments with high- or moderate-confidence evidence for reducing headache frequency.
For episodic migraine, which involves fewer headache days each month, the guideline found high-confidence evidence for:
It found moderate-confidence evidence for:
For chronic migraine — defined as headaches on at least 15 days per month for more than three months, with migraine features on at least eight of those days — the guideline found high-confidence evidence for:
It found moderate-confidence evidence for:
These ratings describe how confident researchers are in the evidence that a treatment reduces headache frequency compared with a placebo (inactive treatment). They don’t mean that one medicine is automatically a better choice for you.
The review also identified preventive treatments with less-certain evidence. Lower-confidence evidence doesn’t necessarily mean a treatment won’t work for an individual. It means researchers have less confidence in the available evidence about its effect.
The 2026 migraine prevention guideline doesn’t name one “best” preventive treatment. Instead, it reflects how many options are now available and puts more emphasis on finding one that fits the individual.
If you have four or more migraine or moderate-to-severe headache days a month — or migraine has a substantial impact on your daily life — the updated guidance suggests it may be worth talking with your doctor about prevention.
Together, you can consider the evidence behind different treatments, possible side effects, how each treatment is taken, cost and access, your health history, and what matters most to you.
Are your headaches a symptom of migraine? Get a quick assessment.
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