AAFP endorses pharmacologic treatment guideline for migraines

The AAFP has endorsed an updated guideline on pharmacologic migraine prevention for adults​ developed by the American Academy of Neurology (AAN) and American Headache Society (AHS). The update reviews established and newer preventive medications, incorporating evidence published since 2012 to help family physicians make informed treatment decisions.

The guideline recommends offering preventive treatment to patients with four or more migraine days per month, four or more moderate-to-severe headache days per month or substantial migraine-related disability. It also emphasizes the need to consider medical history, potential side effects, cost and patient preferences when choosing medications.

This renewed guidance marks an early milestone in a broader collaboration to strengthen headache relief and management in primary care. The AAFP and AAN formed the Neurology Collaboration Steering Group with assistance from AHS to identify practical resources to help family physicians manage headaches, specialty referrals and patient care.

Collaborating for better headache management

Headache management was chosen as the first priority when leadership from the AAFP and AAN met in July 2025 to explore opportunities for collaboration on neurological care. Migraine and tension-type headaches are among the most common headaches patients experience, and family physicians are often the first to evaluate symptoms and begin treatment.

The initiative combines the AAFP’s primary care perspective with the AAN’s neurology expertise and AHS’s focus on headache relief. By working together, the organizations aim to develop a more consistent framework for headache treatment. Along with reducing patient wait time, the goal is to make it easier to refer patients who need treatment outside primary care and to treat those who don’t.

What the collaboration is working on next

The steering group plans to explore clinical guidance, educational materials and decision-making tools to assist with determining which guidelines are most appropriate. Another priority is improving coordination with neurologists and headache specialists, including clearer guidance on when to refer a patient and how to support shared care efforts.

The organizations may also use clinical feedback to identify gaps in existing resources and opportunities for additional support. Better patient education materials can help you guide treatment conversations, encourage self-management resources and provide easy-to-understand information.

Clinical considerations in headache relief

Managing chronic headaches requires clinical decisions that consider how headaches interfere with daily activities and weigh treatment options against a patient’s additional conditions.

Through the steering group, the AAFP can surface members’ clinical questions and workflow roadblocks in discussions with neurology and headache specialists. This perspective can help ensure future guidance is practical for routine visits and increase access for those who need it the most.

What members can expect

As the steering group’s work progresses, the organizations will continue identifying gaps in headache care and developing resources to address them. Members can anticipate updates on the steering group’s progress and additional guidance as they become available.

In the meantime, you can review the pharmacologic treatment guidelines for migraine prevention in adults​ for updated treatment recommendations. Stay informed through AAFP News as the AAFP, AAN and AHS continue to find ways to improve headache care.