Guidance | CHS

Clinical Guidelines

Updated Canadian Headache Society Migraine Prevention Guideline with Systematic Review and Meta-analysis Released

Medrea I. et al. (2024) Updated Canadian Headache Society Migraine Prevention Guideline with Systematic Review and Meta-analysis. The Canadian Journal of Neurological Sciences, 1-23. DOI: 10.1017/cjn.2024.285.

The Canadian Headache Society (CHS) is pleased to announce the publication of the Updated Migraine Prevention Guidelines, which includes a comprehensive systematic review and meta-analysis. This significant update aims to provide healthcare professionals with the latest evidence-based recommendations for the prevention and management of migraine, a condition that affects millions of Canadians. A much-needed update from the 2012 guidelines.

The CHS members have published other guidelines and articles that can be downloaded here:

Position Statements

The Canadian Headache Society (CHS) provides official guidance to support clinicians in delivering evidence-based, ethical, and comprehensive migraine care. The following advocacy resources outline CHS’s position on key issues in access, coverage, and treatment standards.

Not Just Needles: Providing Ethical and Comprehensive Migraine Care

Summary: This statement emphasizes that migraine care must be holistic, not reduced to procedures alone. It calls on providers to deliver comprehensive, ethical care that includes diagnosis, education, lifestyle strategies, and preventive therapies.

Prioritizing Access to Evidence-Based Migraine Preventive Treatments

Summary: CHS urges policymakers and payers to modernize reimbursement policies to reflect current evidence. CGRP monoclonal antibodies and gepants should be considered first-line preventive treatments, improving outcomes and reducing the burden of migraine.

Combination Use of OnabotulinumtoxinA (Botox) and CGRP-Antagonist (CGRPa) Agents for Migraine

Summary: This position highlights the clinical and economic rationale for combination therapy in chronic migraine. CHS stresses the importance of access, noting strong evidence for improved patient outcomes when these treatments are used together.

MAB and BTX Combination Insurance Letter

Summary: CHS addresses recent insurance practices denying concurrent coverage of onabotulinumtoxinA (Botox) and CGRP monoclonal antibodies. This letter details the scientific rationale, clinical experience, and cost-effectiveness supporting combined use in refractory chronic migraine.