Background A previous European Headache Federation (EHF) guideline addressed the use of monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway to prevent migraine. Since then, randomized controlled trials (RCTs) and real-world evidence have expanded the evidence and knowledge for those treatments. Therefore, the EHF panel decided to provide an updated guideline on the use of those treatments. Methods The guideline was developed following the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed a systematic review and an analysis of the literature, assessed the quality of the available evidence, and wrote recommendations. Where the GRADE approach was not applicable, expert opinion was provided. Results We found moderate to high quality of evidence to recommend eptinezumab, erenumab, fremanezumab, and galcanezumab in individuals with episodic and chronic migraine. For several important clinical questions, we found not enough evidence to provide evidence-based recommendations and guidance relied on experts’ opinion. Nevertheless, we provided updated suggestions regarding the long-term management of those treatments and their place with respect to the other migraine preventatives. Conclusion Monoclonal antibodies targeting the CGRP pathway are recommended for migraine prevention as they are effective and safe also in the long-term.

Cognitive performance decreases during migraine attacks, especially in reading and processing speed, verbal memory and learning, supporting patients' subjective complaints. These findings suggest the existence of a reversible brain dysfunction during attacks of migraine without aura, which can relate specifically to migraine or be a consequence of acute pain processing by the brain.

Objectives and Background.— The possible effects of migraine on executive abilities remain controversial; hence, we studied inter‐ictal cognitive performance of individuals with migraine and non migraine headaches (NMH) compared with headache free controls. Design and Method.— In a cross‐sectional observational study, taking place in primary care, adults aged 50 or above were evaluated by a neurobehavioral battery including several executive measures. Present history of headache was sought, and migraine was diagnosed by the ID‐Migraine questionnaire. The effect of headache type on cognitive measures was analyzed with multiple regression with adjustment by diagnosis, age, gender, education, and depressive symptoms. Results.— Among 478 participants, 23.2% reported current headache, of whom 50 were NMH, and 61 were migraine headaches. No group differences were found in the majority of cognitive measures. Compared with controls, migraine subjects performed worse on a test of attention, while NMH participants presented more intrusions and worse discriminability in memory recognition plus a lower performance on semantic memory tests. Conclusion.— The presence of headaches in late adulthood was related to a worse performance on few measures of executive functioning, suggesting that cognitive impact is not specific to migraine but might be associated to headache.