Advances in migraine prevention - 19/02/26

Doi : 10.1016/S1474-4422(25)00477-6

Daniele Martinelli, MD ^a, Roberto De Icco, MD ^a,^b, Haidar M Al-Khazali, MD ^c, Sait Ashina, MD ^d, Hans-Christoph Diener, ProfMD ^e, Freda Dodd-Glover, MD ^f, Maria Teresa Goicochea, MD ^g, Bronwyn Jenkins, MD ^h, Antoinette MaassenVanDenBrink, ProfPhD ⁱ, Mi Ji Lee, MD ^j, Aynur Özge, ProfMD ^k,^l, Mario Fernando Prieto Peres, ProfMD ^m, Patricia Pozo-Rosich, MD ^n,^o, Francesca Puledda, MD ^p, Simona Sacco, ProfMD ^q, Todd Schwedt, ProfMD ^r, Gisela M Terwindt, ProfMD MSc ^s, Cristina Tassorelli, ProfMD ^a,^b,⁎

^a Headache Science and Rehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy

^b Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

^c Department of Neurology, Danish Headache Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark

^d Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

^e Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University Duisburg–Essen, Essen, Germany

^f Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana

^g Neurology Department, Headache Clinic, Fleni, Buenos Aires, Argentina

^h Royal North Shore Hospital, Sydney, NSW, Australia

ⁱ Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands

^j Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

^k Department of Neurology, Mersin University School of Medicine, Mersin, Türkiye

^l NÖROM Neuroscience and Excellence Center, Ankara, Türkiye

^m Institute of Psychiatry, HCFMUSP, Sao Paulo, Brazil

ⁿ Headache Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain

^o Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research, Barcelona, Spain

^p Headache Group, Wolfson SPaRC, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

^q Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy

^r Department of Neurology, Mayo Clinic, Phoenix, AZ, USA

^s Department of Neurology, Leiden University Medical Center, Leiden, Netherlands

^* Correspondence to: Prof Cristina Tassorelli, Headache Science and Rehabilitation Unit, IRCCS Mondino Foundation, Pavia 27100, Italy Headache Science and Rehabilitation Unit IRCCS Mondino Foundation Pavia 27100 Italy

Summary

Migraine imposes a heavy burden on patients and societies. Preventive treatments aimed at reducing the occurrence of migraine attacks and their intensity have been largely underused, leaving a multitude of people with migraine to rely exclusively on acute treatments, which, when used in excess, might even worsen the clinical situation. Large, randomised trials have established the tolerability and efficacy of calcitonin gene-related peptide (CGRP)-targeting drugs, a new class of migraine-specific treatment. The increased adherence to longer treatment cycles with migraine-specific preventive drugs, such as CGRP-targeting therapies, compared with non-migraine specific treatments has the potential to improve control of the disease. These migraine-specific drugs also provide benefits to individuals with migraine who previously did not benefit from non-specific migraine preventive medications. Increased reliance on preventive treatment with migraine-specific options is progressively optimising the management of migraine for mounting numbers of patients disabled by the disease, thereby improving disease control and their quality of life.

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Plan

Introduction

Definition of migraine prevention and its indications

Pharmacological treatments in migraine prevention

From repurposed drugs to the new migraine-specific preventive medications

Current guidelines for migraine prevention

Reshaping clinical management of migraine

Key aspects for disease control

Specific approaches in special populations

Emerging therapies and potential new targets

Conclusions and future directions

Search strategy and selection criteria

Contributors

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Vol 25 - N° 3

P. 279-293 - mars 2026 Retour au numéro

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Advances in migraine prevention - 19/02/26

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