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The updated American Academy of Neurology (AAN)/American Headache Society (AHS) guidelines for pharmacologic prevention of migraine in adults were published this week in Neurology and endorsed by the American Academy of Family Physicians. The guidelines suggest a migraine visit should also be considered as an opportunity for clinicians to identify patients who need preventive therapy beyond just treatment for the acute event. According to the update, preventive treatment should be offered to adults with 4 or more migraine days per month, 4 or more moderate-to-severe headache days per month, or migraine that interferes with work or daily activities. It’s important to note that no single medication has been shown to be clearly superior in reducing the frequency of migraine attacks, so clinicians should consider clinical factors, comorbidities, quality-of-life impact, and patient preferences. The guidelines specifically address patients with conditions such as hypertension, obesity, and fibromyalgia, as well as older adults and those who are pregnant or breastfeeding.
Watch for red flags nonetheless: For urgent care, the practice adjustment is more about the opportunity for preventive therapy, even if that means a referral to a neurologist or primary care provider. The prevention guidelines don’t change headache red-flag assessment or indications for emergency department transfer either. Severe, sudden headaches might not be migraines after all. Read about an urgent care case from the JUCM archive: Expanding the Differential of Thunderclap Headache Beyond Subarachnoid Hemorrhage: A Case Report