Health
American medical groups issue first migraine prevention guidelines since 2012
The updated guidance incorporates newer FDA-approved treatments, but some experts warn the complex recommendations could confuse primary care doctors and lead to insurance denials.
The short version
- The American Academy of Neurology and the American Headache Society have updated their migraine prevention guidelines for the first time in over a decade.
- The guidelines incorporate several newer medications approved since 2012, including at least half a dozen that block the CGRP pathway.
- Medical experts have raised concerns that the complexity of the updated guidelines and contradictions regarding pregnancy safety might complicate clinical use and prompt insurers to deny coverage.
Key facts
- The American Academy of Neurology and the American Headache Society updated their migraine prevention guidelines on Monday, marking the first update since 2012.[STAT]
- The development process for the new guidelines began in January 2018 and involved a panel of 19 headache specialists and researchers from the U.S. and Canada.[STAT]
- The guidelines recommend doctors offer preventive treatment to individuals who experience four or more migraine days per month, or whose migraines disrupt daily work and tasks.[STAT]
- At least six FDA-approved medications targeting the calcitonin-gene related peptide (CGRP) pathway, including atogepant, eptinezumab, erenumab, fremanezumab, and galcanezunab, are included in the new guidance.[STAT]
- The scientific review behind the guidelines deems the tricyclic antidepressant amitriptyline a viable migraine prevention option for certain pregnant patients, which contradicts guidance from the American College of Obstetricians and Gynecologists advising against tricyclic antidepressants during pregnancy.[STAT]
What remains uncertain
- Independent experts, including the immediate past president of the American Headache Society, warn that complex multi-layered recommendations might deter primary care doctors from prescribing the treatments and give insurance payers grounds to deny patient coverage.[STAT]