IHS, ACP Differ on Migraine Tx

Experts highlight differences between IHS and ACP recommendations as newer therapies reshape acute and preventive migraine care

By
Kathryn Wighton
April 14, 2026
4 min

Conexiant

Objective:

To compare guideline recommendations from the International Headache Society (IHS) and the American College of Physicians (ACP) regarding optimal acute and preventive treatment strategies for migraine.

Approach:

Key Findings:

IHS recommends triptans as first-line acute therapy; ACP suggests triptans combined with NSAIDs or acetaminophen.
Triptans show higher efficacy than NSAIDs in achieving pain freedom at 2 hours, with specific odds ratios.
Preventive therapy trials lack high-quality evidence, with no significant differences in efficacy among treatments.
CGRP-targeting therapies may offer faster response but at a higher cost compared to traditional oral medications, with specific cost comparisons.

Interpretation:

Treatment strategies for migraine should be individualized, considering patient-specific factors and the differing recommendations from IHS and ACP, emphasizing the need for a patient-centered approach.

Limitations:

Most studies on preventive therapies are placebo-controlled, limiting comparative evidence and generalizability.
The APPRAISE trial's population may not be generalizable as it included only patients with prior treatment failure, which could skew results.

Conclusion:

A patient-centered approach is essential in migraine management, taking into account clinical variables, treatment history, and individual patient needs.