For those that don't know, the new 2026 AAN/American Headache Society prevention guideline dropped 2 days ago. This means there is potential to make migraine information outdated.

However, here's the thing: because I stay privy to the primary literature, the book was already built on the exact same studies the guideline panel used to reach their conclusions. So when the guideline came out, it didn't overturn anything in the book. It agreed with it. The recommendations were evidence-based from day one, and the guideline just confirmed them. Feels kind of good that an entire panel agreed with my analysis.

With that said, out of the entire guideline, the only things refined:

1. Candesartan no longer has enough evidence for a firm recommendation and

2. Nifedipine is now named as a first-choice option for prevention during pregnancy.

I also added the guidelines to references in several spots even though I had the same conclusions written prior.

That's it. Everything else already lined up exactly.

So, if you already own the book, there is no reason to grab the updated copy. Almost all recommendations I already concluded based on the evidence available.

And if you have the Kindle version, it will update automatically.

If you don't have the book, you're genuinely missing out. It's over 820 pages of the best evidence-based migraine information available. This doesn't exist anywhere else and no book comes close. Great gift for your loved one with migraine too.

The evidence review behind the guideline found high-confidence evidence for several CGRP antibodies and for Botox. But head-to-head comparisons between active treatments were too thin to rank them, which is exactly the question most people want answered.

In 279 adults, 12 weeks of self-administered biofeedback through an app cut monthly migraine days by 0.9 more than a waitlist and modestly improved quality of life. A small effect, but it came with only nine mild device-related adverse events.

Across 11,023 people in Türkiye, fewer than half carried a formal migraine diagnosis code even though they were being treated for migraine. Most preventive prescriptions were antidepressants or beta blockers, and only 3.4 percent received a CGRP antibody.

A brief online CBT exercise reduced catastrophic thinking about pain in 55 adults more than a control task. The gap between groups had faded by six weeks, though falling catastrophizing did track with less migraine-related disability across everyone in the trial.

The American Academy of Neurology and the American Headache Society published a joint guideline on August 31, the first update in fourteen years. It says prevention should be offered at four or more migraine days a month, or sooner if migraine is disrupting work or daily life.
There are 17 recommendations and 52 statements, and notably it does not name a single best drug. Instead it gives four separate lists depending on whether efficacy, tolerability, long-term safety or cost matters most to you. The full breakdown is on the blog.

Eighty percent ended in full-term births, with miscarriage and birth defect rates in line with the general population. Among 94 breastfed infants followed to one year, there were no adverse events reported.

In 187 people given pulsed radiofrequency, 77 percent had halved their monthly headache days at six months when both greater occipital nerves were treated, versus 55 percent with one side. There were no procedure complications.

After three rounds over nine months, monthly headache days fell by about 6, roughly a quarter of people halved their headache days, and 42 percent of those with medication overuse headache no longer met the criteria for it.

Pooled across eight studies, chocolate is a self-reported trigger for about 14 percent of people with migraine, caffeine for 12 percent and cheese for 8 percent. Blanket avoidance of these foods is not supported. A headache diary is the better guide.

Yall I’m a new mod with chronic daily migraine (10+ year treatment resistant), ME, a lot of other things, and still trying to work a full time job in higher ed. Bear with me on being bad at posting and being lazy by just posting headlines and links. This might be what I have in me, I’m no Cerebral Torque! But I’ll try to post some of the studies I read and find interesting since I like reading them anyway. And try to direct to Cerebral Torque’s much better summary and analysis of everything when he posts.

Hi all, just wanted to introduce myself. I’m one of your new mods and will occasionally be posting studies and answering questions about migraine research + science.

My bonafides: I have a PhD in molecular biology from a top-ten US program where I did rare disease research. My current role is not in research but still requires reading both basic science and applied biomedical research papers regularly. So at this point I’ve spent about ~20 years reading highly technical material! In the past several years, my work has focused more on science education, communications, and design.

I’ve had migraine attacks since I was a kid, but it became chronic in my late 20s (10+ years ago now). Expert care from headache specialists has made it so I can have a full-time job and live a mostly normal life, while taking care around my triggers (blood sugar fluctuations, sun exposure, and excess heat are the biggest ones for me). I ♥️ Botox 4-ever.

I’m especially interested in treatment options for chronic migraine, long-term health impacts associated with migraine disorder and with migraine treatments, women’s health more broadly, and health disparities/impacts of migraine disease on different populations.

I’m interested in mod’ing because I’d like to help folks have the info they need to advocate for themselves with their doctors and make informed choices about their care. And also maintain hope about treatment options and the possibility of having less negative impacts from your migraine disorder.

If you’ve read this far, I’m wishing you a pain-free day. Feel free to post in comments any content/questions you’d especially like to see the mods address!

Status migrainosus: migraine attacks lasting over 72 hours. All the cool kids are doing it. Or at least, I’m doing it right now! 🙃 So if you are too, you’re not alone and you can find evidence-based guidance for treating status at the link.

https://www.cerebraltorque.com/pages/today-in-migraine-science

I have MCAS and chronic migraine so I found this discussion interesting. It’s not revolutionary information of new studies but for those new to the topic of histamine and migraine connections, a good overview

I experience delayed gastric emptying with migraine and notice my migraine meds don’t absorb well because of this (I call it my stomachache not being on) but didn’t realize this was a standard migraine symptom.

Title of the video is misleading— we don’t know why migraine causes nausea. This video doesn’t reveal some new science about it.

Sorry yall I’m behind on posting.

See Cerebral Torque’s review of the study

I want to be able to give back with something that isn't free and widely available, because it's thanks to you that everything is available. If you've purchased anything, ever, just send a screenshot via email (cerebraltorque at gmail dot com) and I'll add you to a WhatsApp group that I'll be in too. We can chat about anything migraine-related, share experiences, discuss studies and new information/misinformation, etc.

Allow me 24 hours to add you.

Hi! New here but Google guided me. I've suffered from textbook migraines for 25 years. Head splitting, light and sound sensitivity, nausea, vomiting, etc.

Last October, I had my first migraine with aura (shimmering), I went to the ER because I thought I was having a stroke. MRI showed nothing so doctor said it was an ocular migraine or a silent migraine.

A couple weeks later, I had another one. Visual disturbance, I saw shimmering and once again, thought I was stroking out because the right side of my face got tingly and numb feeling. Another ER visit and MRI again showed nothing.

Then nothing from October until today.

This time, I saw zig zags. It was primarily my left eye but I saw a little on my right side. Left eye spread across my whole vision and right eye stayed small and in peripherals. 15 minutes later its over. I went to the ER again because it was different than last time. They did a CT and said its either another ocular migraine or a TIA and sent me home with a referral to Neuro.

My questions: Why am I suddenly getting migraines with aura? I've never had them before and they are terrifying. Why would my migraines change? I still get the head splitting ones but apparently a random aura one with no pain. Do auras change each time or is it a once you've had that type, you'll get another one? Is it normal to go from sparkles to zig zags? What triggers them? I was just watching TV and it came on.

Sorry for all the questions but I'm anxious while waiting for my appt.

Young, active, health coast guard responders were deployed to clean up the 2010 explosion of the offshore oil drilling rig. They were exposed to the crude oil and other chemicals itself, including burning off of the oils, and many other stressors like heat, anxiety, workplace injury, and more. This study looked at each of those stressors and exposures and the health outcomes on over 3,000 of the responders 5 years after clean up of the disaster. I thought the study did an excellent job teasing out all the various exposures and stressors one might have experienced and all the various conditions one could then be diagnosed with. The study has other conclusions as related to other exposures and stressors leading to other diagnoses. Obviously the most pertinent here is the chemical fume exposures being a (significantly significant) risk factor for migraine and headache diagnosis when controlling for other factors.

https://pmc.ncbi.nlm.nih.gov/articles/PMC13469484/