New American College of Physicians Guidelines for Prevention of Episodic Migraine

These guidelines include first-line recommendations consisting of beta-blockers, amitriptyline, venlafaxine, divalproex, with drugs that target calcitonin gene-related peptide as a second-line alternative.

Sponsoring Organization: American College of Physicians (ACP)

Target Audience: Primary care physicians who often encounter patients naive to migraine-preventive drugs

Target Population: Adult patients with episodic migraine

Background and Objective

To establish recommendations for nonpregnant adults who need prevention for episodic migraine (1–14 migraine days per month), the authors conducted two systematic reviews and a network meta-analysis.

Key Points

Consider preventive therapy for episodic migraine in a patient with a history of debilitating migraine and contraindications or inadequate response to acute treatment.
Start with a beta-adrenergic blocker, valproate, venlafaxine, or amitriptyline.
Start with a low dose and increase it slowly, emph…

Reviewing Author

Teshamae Monteith, MD

Disclosures

Consultant/Advisory BoardAbbVie; Axsome; Teva; Linpharma; e-Neura; Novartis; Merz; Lundbeck; Axsome; Pfizer. Unpaid co-author for collaborative research sponsored by AbbVie, Pfizer/Biohaven, and Theranica.

RoyaltiesSpringer

Editorial BoardsCephalalgia; Continuum Audio; Neurology Minute; Neurology; American Migraine Foundation; Brain and Life Magazine

Leadership Positions in Professional SocietiesFlorida Society of Neurology (member, Executive Board); American Migraine Foundation (member, Executive Board); United Councils of Neurologic Subspecialities Examination Committee (Vice Chair)

OtherPaid speaking/education for Medscape, Massachusetts Medical Society, American Headache Society, and American Academy of Neurology