Skip to main content

Table 1 Recommendations by various institutes and headache federations. Abbreviations: CM = chronic migraine; EM = episodic migraine, MHD = monthly headache days

From: The sense of stopping migraine prophylaxis

Institute or federation

Positive stopping rules

Negative stopping rules

Treatment

National Institute for Health and Care Excellence [56]

Discontinue treatment when a patient has regressed from CM to EM over three consecutive months

Discontinue treatment when a patient does not achieve a reduction of 30% or more in MHDs after two treatment cycles

OnabotulinumtoxinA

European Headache Federation expert consensus [57]

Stop treatment if a patient reaches a reduction to fewer than 10 headache days per month for three consecutive months. Re-evaluate after four to five months

Stop treatment if a patient does not respond during the first two to three treatment cycles

OnabotulinumtoxinA

American College of Physicians and American Academy of Family Physicians [58]

After a period of stability, clinicians are advised to consider tapering or discontinuing treatment, taking into account the patient’s wishes and expectations

 

All preventatives

British Association for the Study of Headache [59]

Consider gradual withdrawal after 6 to 12 months of effective prophylactic treatment

 

All preventatives

Canadian Headache Society [60]

After 6 to 12 months of successful prophylactic therapy, consider tapering and discontinuing the prophylactic medication

A prophylactic medication should be administered for at least two months at the maximum tolerated, target, or optimal dose before being considered ineffective

All preventatives