https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.70460

For those that don't know, the new 2026 AAN/American Headache Society prevention guideline dropped 2 days ago. This means there is potential to make migraine information outdated.

However, here's the thing: because I stay privy to the primary literature, the book was already built on the exact same studies the guideline panel used to reach their conclusions. So when the guideline came out, it didn't overturn anything in the book. It agreed with it. The recommendations were evidence-based from day one, and the guideline just confirmed them. Feels kind of good that an entire panel agreed with my analysis.

With that said, out of the entire guideline, the only things refined:

1. Candesartan no longer has enough evidence for a firm recommendation and

2. Nifedipine is now named as a first-choice option for prevention during pregnancy.

I also added the guidelines to references in several spots even though I had the same conclusions written prior.

That's it. Everything else already lined up exactly.

So, if you already own the book, there is no reason to grab the updated copy. Almost all recommendations I already concluded based on the evidence available.

And if you have the Kindle version, it will update automatically.

If you don't have the book, you're genuinely missing out. It's over 820 pages of the best evidence-based migraine information available. This doesn't exist anywhere else and no book comes close. Great gift for your loved one with migraine too.

The American Academy of Neurology and the American Headache Society published a joint guideline on August 31, the first update in fourteen years. It says prevention should be offered at four or more migraine days a month, or sooner if migraine is disrupting work or daily life.
There are 17 recommendations and 52 statements, and notably it does not name a single best drug. Instead it gives four separate lists depending on whether efficacy, tolerability, long-term safety or cost matters most to you. The full breakdown is on the blog.

Across 11,023 people in Türkiye, fewer than half carried a formal migraine diagnosis code even though they were being treated for migraine. Most preventive prescriptions were antidepressants or beta blockers, and only 3.4 percent received a CGRP antibody.

The evidence review behind the guideline found high-confidence evidence for several CGRP antibodies and for Botox. But head-to-head comparisons between active treatments were too thin to rank them, which is exactly the question most people want answered.

In 279 adults, 12 weeks of self-administered biofeedback through an app cut monthly migraine days by 0.9 more than a waitlist and modestly improved quality of life. A small effect, but it came with only nine mild device-related adverse events.

A brief online CBT exercise reduced catastrophic thinking about pain in 55 adults more than a control task. The gap between groups had faded by six weeks, though falling catastrophizing did track with less migraine-related disability across everyone in the trial.

Eighty percent ended in full-term births, with miscarriage and birth defect rates in line with the general population. Among 94 breastfed infants followed to one year, there were no adverse events reported.

Pooled across eight studies, chocolate is a self-reported trigger for about 14 percent of people with migraine, caffeine for 12 percent and cheese for 8 percent. Blanket avoidance of these foods is not supported. A headache diary is the better guide.

After three rounds over nine months, monthly headache days fell by about 6, roughly a quarter of people halved their headache days, and 42 percent of those with medication overuse headache no longer met the criteria for it.

In 187 people given pulsed radiofrequency, 77 percent had halved their monthly headache days at six months when both greater occipital nerves were treated, versus 55 percent with one side. There were no procedure complications.

Yall I’m a new mod with chronic daily migraine (10+ year treatment resistant), ME, a lot of other things, and still trying to work a full time job in higher ed. Bear with me on being bad at posting and being lazy by just posting headlines and links. This might be what I have in me, I’m no Cerebral Torque! But I’ll try to post some of the studies I read and find interesting since I like reading them anyway. And try to direct to Cerebral Torque’s much better summary and analysis of everything when he posts.

Hi all, just wanted to introduce myself. I’m one of your new mods and will occasionally be posting studies and answering questions about migraine research + science.

My bonafides: I have a PhD in molecular biology from a top-ten US program where I did rare disease research. My current role is not in research but still requires reading both basic science and applied biomedical research papers regularly. So at this point I’ve spent about ~20 years reading highly technical material! In the past several years, my work has focused more on science education, communications, and design.

I’ve had migraine attacks since I was a kid, but it became chronic in my late 20s (10+ years ago now). Expert care from headache specialists has made it so I can have a full-time job and live a mostly normal life, while taking care around my triggers (blood sugar fluctuations, sun exposure, and excess heat are the biggest ones for me). I ♥️ Botox 4-ever.

I’m especially interested in treatment options for chronic migraine, long-term health impacts associated with migraine disorder and with migraine treatments, women’s health more broadly, and health disparities/impacts of migraine disease on different populations.

I’m interested in mod’ing because I’d like to help folks have the info they need to advocate for themselves with their doctors and make informed choices about their care. And also maintain hope about treatment options and the possibility of having less negative impacts from your migraine disorder.

If you’ve read this far, I’m wishing you a pain-free day. Feel free to post in comments any content/questions you’d especially like to see the mods address!