2025 Summary of ACP Recommendations for Preventing Episodic Migraines in Nonpregnant Adults
1. First-Line Treatment: Clinicians should initiate monotherapy with one of the following:
▪️Beta-blockers (metoprolol or propranolol)
▪️Antiseizure medication (valproate)
▪️SNRI (venlafaxine)
▪️Tricyclic antidepressant (amitriptyline)
2. Second-Line Treatment: If the first-line options are not tolerated or ineffective, clinicians should consider monotherapy with:
▪️A CGRP antagonist-gepant (atogepant or rimegepant)
▪️A CGRP monoclonal antibody (eptinezumab, erenumab, fremanezumab, or galcanezumab)
3. Third-Line Treatment: If both first- and second-line treatments fail, clinicians may use monotherapy with the antiseizure medication topiramate.
Full guideline: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01052
@HakimApps_Guideline
1. First-Line Treatment: Clinicians should initiate monotherapy with one of the following:
▪️Beta-blockers (metoprolol or propranolol)
▪️Antiseizure medication (valproate)
▪️SNRI (venlafaxine)
▪️Tricyclic antidepressant (amitriptyline)
2. Second-Line Treatment: If the first-line options are not tolerated or ineffective, clinicians should consider monotherapy with:
▪️A CGRP antagonist-gepant (atogepant or rimegepant)
▪️A CGRP monoclonal antibody (eptinezumab, erenumab, fremanezumab, or galcanezumab)
3. Third-Line Treatment: If both first- and second-line treatments fail, clinicians may use monotherapy with the antiseizure medication topiramate.
Full guideline: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01052
@HakimApps_Guideline