A global comparison of clinical guidelines for the diagnosis and management of migraine: similarities, differences, and gaps
Abstract
PURPOSE OF REVIEW
To compare international clinical guidelines for migraine diagnosis and management, identifying consensus, differences, and gaps.
RECENT FINDINGS
Assessed guideline repositories and society websites from 2012 to 2025 for recommendations from American, British, Italian, Japanese, French, and International Headache Society (IHS) guidelines. All guidelines base diagnosis on International Classification of Headache Disorders (ICHD-3) and recommend early acute therapy with analgesics and NSAIDs. Triptans are universally endorsed for moderate-to-severe attacks, while gepants and ditans appear in newer guidelines but remain inaccessible in many countries. Preventive therapy is advised for frequent or disabling attacks; recommended first-line agents include beta-blockers (propranolol), antiseizure medications (ASMs) (topiramate, valproate), and tricyclic antidepressants (amitriptyline). Calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants are positioned as first-line by American and Japanese guidelines but restricted in Britain and France. OnabotulinumtoxinA is reserved for chronic migraine after several failed oral preventives. Nonpharmacological interventions such as neuromodulation and behavioral therapies are increasingly incorporated. Differences stem primarily from drug availability and insurance coverage. Evidence gaps persist for pediatric, geriatric, and pregnant populations and long-term safety of emerging therapies.
SUMMARY
Despite…
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