What New Migraine Guidelines Mean For You

If you’ve ever had a migraine, you know how painful they can be. Frequent migraines can have a profound impact on your quality of life and keep you from work and activities you enjoy, but they are not uncommon. Over 37 million people suffer from migraines in the United States, and it’s considered the 10th most debilitating medical condition.

Unfortunately, migraines can be difficult to treat because every case is different. However, new guidelines issued by the American Academy of Neurology are helping doctors manage migraines more effectively. 

“The last set of guidelines was from 2012; the landscape of migraine preventive treatment has changed drastically since then. Our understanding of migraines has changed over the years, and treatments have improved,” says Adil F. Niaz, D.O., neurologist at Hackensack Medicine Neuroscience Institute at Jersey Shore University Medical Center.

Dr. Niaz breaks down five key takeaways from the updated guidelines.

1. Doctors Can Treat Migraines Sooner

In the past, Dr. Niaz says that many physicians were trained to offer preventive treatment for migraines after patients experienced eight or more migraines a month. However, the new guidelines lower the number of migraines necessary each month to just four. 

Dr. Niaz stresses the importance of talking to your doctor, even if you don’t think you meet the criteria. “If people are having inadequate response to medication or severe, disabling attacks, we don’t want to withhold prevention,” he says. 

2. Migraine Specific Therapies Offered First

Physicians are now also encouraged to offer migraine-specific calcitoningene-relatedpeptide(CGRP)therapiesalongsidetraditionalpreventiveoptionsasafirst-line defense. These modern, targeted medications are designed to prevent or stop migraine attacks. 

Dr. Niaz says there are several preventive migraine medications available. He recommends speaking with your doctor about how migraines affect your daily life to find the one that works best for you. 

“Chronic migraine is treatable. The goal is to reduce both the number and severity of headaches and improve daily function. Frequent use of acute medications can make headaches more frequent in some patients, so medication use is an important part of treatment,” he says. 

In addition to treatment, Niaz also says lifestyle factors can affect the frequency of migraines. He encourages migraine sufferers to get regular sleep, eat a well-balanced diet and exercise. 

3. Shared Decision Making Encouraged

Dr. Niaz says he was pleased to see the emphasis on shared decision-making in the updated guidelines. Shared decision-making is a collaborative process in which doctors and patients work together to find the best solution.

“I really appreciate this tone throughout the guidelines, as it reflects my clinical practice. Patients experiencing migraine must be offered a choice to individualize their care to a degree,” he says. 

4. Two Cycles of Botox Recommended

Botox is used as a preventive measure for those who have chronic migraines or more than 15 migraines a month. The medical treatment, which was approved by the Food and Drug Administration, works by blocking the chemicals that carry pain signals from your head and neck to your brain. 

Botox doesn’t work instantly. Clinical trials have shown it can take at least two rounds of Botox to see results. Botox injections are given every 12 weeks for migraine prevention. That’s why the new guidelines recommend waiting 24 weeks to assess the efficacy of Botox.

5. No Detox Period

In the past, people who suffered from medication-overuse headache, worsening of migraines from frequent use of acute treatments, would need to taper off the medication before starting anything else. The process could be painful and take several weeks. New guidelines recommend that doctors use preventive treatments right away to help people transition off the medication.

Dr. Niaz stresses the importance of speaking with your doctor about your migraine treatment and any side effects you may have. 

“We have a better understanding of medication overuse, the importance of prevention and the need to tailor treatment to each patient,” says Dr. Niaz. 

Next Steps & Resources

• Meet our source: Adil F. Niaz, D.O.
• Learn more about Headache and Migraine Treatment at Hackensack Meridian Health.