Summary of Statements

Document Overview

Design and created by Guideline Central in participation with the American Headache Society.

Calcitonin Gene-related Peptide-Targeting Therapies for Prevention of Migraine

American Headache Society

Publication Date: Mar 11, 2024

Page Last Updated: May 6, 2026

Table 1. Indications for initiation of calcitonin gene-related peptide-targeting therapies for migraine in previous American Headache Society consensus statement

Use is appropriate when A, B, and either C, D, or E are met:
Prescribed by a licensed clinician
Patient is at least 18 years of age
Diagnosis of ICHD-3 migraine with or without aura (4–7 MMDs) and both of the following:
- Inability to tolerate (due to side-effects) or inadequate response to an 8-week trial at a dose established to be potentially effective of two or morea of the following:
  - Topiramate
  - Divalproex sodium/valproate sodium
  - Beta-blocker: metoprolol, propranolol, timolol, atenolol, nadolol
  - Tricyclic antidepressant: amitriptyline, nortriptyline
  - Serotonin-norepinephrine reuptake inhibitor: venlafaxine, duloxetine
  - Other Level A or B treatments (established efficacy or probably effective) according to AAN scheme for classification of evidence10
- At least moderate disability (MIDAS score ≥11 or HIT-6 score >50
Diagnosis of ICHD-3 migraine with or without aura (8–14 MMDs) and inability to tolerate (due to side-effects) or inadequate response to an 8-week trial of two or morea of the following:
- Topiramate
- Divalproex sodium/valproate sodium
- Beta-blocker: metoprolol, propranolol, timolol, atenolol, nadolol
- Tricyclic antidepressant: amitriptyline, nortriptyline
- Serotonin-norepinephrine reuptake inhibitor: venlafaxine, duloxetine
- Other Level A or B treatments (established efficacy or probably effective) according to AAN scheme for classification of evidence
Diagnosis of ICHD-3 chronic migraine and EITHER a or b:
- Inability to tolerate (due to side-effects) or inadequate response to an 8-week trial of two or morea of the following:
  - Topiramate
  - Divalproex sodium/valproate sodium
  - Beta-blocker: metoprolol, propranolol, timolol, atenolol, nadolol
  - Tricyclic antidepressant: amitriptyline, nortriptyline
  - Serotonin-norepinephrine reuptake inhibitor: venlafaxine, duloxetine
  - Other Level A or B treatments (established efficacy or probably effective) according to AAN scheme for classification of evidence
Inability to tolerate or inadequate response to a minimum of two quarterly injections (6 months) of onabotulinumtoxinA

Document Overview

Document Title: Calcitonin Gene-related Peptide-Targeting Therapies for Prevention of Migraine

Authoring Society: American Headache Society

Document Publication Date: Mar 11, 2024

Page Last Reviewed/Updated: May 6, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.14692

Source Citation: Charles AC, Digre KB, Goadsby PJ, Robbins MS, Hershey A; American Headache Society. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update. Headache. 2024 Mar 11. doi: 10.1111/head.14692. Epub ahead of print. PMID: 38466028.

Document Scope, Criteria, and Use Cases

Document Objectives: To provide a position statement update from The American Headache Society specifically regarding therapies targeting calcitonin gene-related peptide (CGRP) for the prevention of migraine. The CGRP-targeting migraine therapies are a first-line option for migraine prevention. Initiation of these therapies should not require trial and failure of non-specific migraine preventive medication approaches.

Scope: Management

Diseases/Conditions (MeSH)

D008881 - Migraine Disorders

Keywords: CGRP, migraine

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Calcitonin Gene-related Peptide-Targeting Therapies for Prevention of Migraine

Summary of Statements

Table 1. Indications for initiation of calcitonin gene-related peptide-targeting therapies for migraine in previous American Headache Society consensus statement

Table 2. Updated recommendations for migraine prevention

Document Overview

Document Scope, Criteria, and Use Cases