State of the Art in the Management of Migraine: A Response to the American College of Physicians Migraine Preventive Treatment Guideline

The document critiques the American College of Physicians (ACP) guideline for migraine preventive therapy, arguing it is based on flawed analysis and incomplete data, leading to recommendations with low confidence. The authors highlight the discrepancy between the ACP's recommendations and those of the American Headache Society, emphasizing the lack of consideration for the number of studies and participants involved in the ACP's analysis. They point out that many therapies recommended by the ACP as "first-line" are not FDA-approved for migraine prevention and have significant safety and tolerability issues, such as valproate, which is contraindicated for women of childbearing age. In contrast, CGRP-targeting therapies, which are FDA-approved and supported by extensive research, are not adequately considered in the ACP guideline. The authors stress the importance of individualized treatment approaches and the need to prioritize patient safety and well-being over cost considerations. They express a desire to collaborate with the ACP to improve migraine management guidelines.