The American College of Physicians issued updated guidelines ranking migraine prevention drugs, including CGRP antibodies and gepants alongside traditional treatments.
ACP GuidelineMajor US clinical practice guideline for episodic migraine prevention published in Annals of Internal Medicine
What the researchers found
ACP guidelines provide evidence-based ranking of migraine prevention drugs including CGRP-targeted therapies alongside traditional options.
Why it matters
This is a major US guideline — its recommendations will influence prescribing patterns and insurance coverage decisions for millions of migraine patients.
The numbers in context
Covers 8 drug classes; evaluates comparative effectiveness for episodic migraine (1-14 days/month); uses GRADE methodology.
How the study worked
Clinical practice guideline based on systematic reviews of comparative effectiveness, patient values, and economic evidence.
Who was studied
Adults with episodic migraine in outpatient settings
What this study cannot tell us
Guidelines rely on available evidence, which may be limited for newer agents. Cost-effectiveness varies by healthcare system.
How to read the evidence
Clinical practice guideline — highest level of evidence synthesis, directly informing clinical care.
When this study was published
Published in 2025, reflecting the most current evidence on migraine prevention strategies.
The bigger picture
Including CGRP-targeted therapies in a major primary care guideline represents their full acceptance into mainstream migraine prevention.
Questions still open
- Are CGRP drugs recommended first-line or only after traditional drug failure?
- How will insurance companies respond to these guideline recommendations?
Common questions
What does this guideline recommend for migraine prevention?
Are CGRP drugs now first-line for migraine prevention?
Read the original research
Prevention of Episodic Migraine Headache Using Pharmacologic Treatments in Outpatient Settings: A Clinical Guideline From the American College of Physicians.
Annals of internal medicine, 178(3), 426-433
Citation
Qaseem, Amir; Cooney, Thomas G; Etxeandia-Ikobaltzeta, Itziar; Wilt, Timothy J; Harrod, Curtis S; Tice, Jeffrey A; Crandall, Carolyn J; Hicks, Lauri A; Cross, J Thomas; Fitterman, Nick; Lewis, Johanna; Linsky, Amy M; Maroto, Michael; Miller, Matthew C; Obley, Adam J; Owens, Douglas K; Shekelle, Paul G; Shamliyan, Tatyana; Yost, Jennifer. (2025). Prevention of Episodic Migraine Headache Using Pharmacologic Treatments in Outpatient Settings: A Clinical Guideline From the American College of Physicians.. Annals of internal medicine, 178(3), 426-433. https://doi.org/10.7326/ANNALS-24-01052