A LITTLE LIGHTBULB MOMENT
Therapeutics · Migraine
Migraine prevention: frequency and function
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4 days = prevention talk
The idea behind the cue
Offer preventive treatment with four or more monthly migraine days, four or more moderate-to-severe headache days, or meaningful functional impairment.
Practice this flashcard →Make it memorable
Short & simple
4 days = prevention talk
Acronym
4F: Four days or Function affected? Flag prevention.
Story
A calendar with 4 headache stickers and a tiny office chair says, “This migraine is ruining my function—time to discuss prevention.”
Connect the pieces
- Decode the mnemonic: 4F: Four days or Function affected? Flag prevention.
Know the limits
Prevention is different from treating a single attack; choices require individual assessment.
AAN/AHS migraine prevention guideline announcement · 2026 ↗Drug guide: Migraine
Adult preventive therapy; acute attack treatment is a separate decision.
- topiramate, propranolol: Oral prevention options
- atogepant, erenumab, fremanezumab, galcanezumab, eptinezumab: CGRP-targeted prevention options
Discuss prevention when migraine frequency or disability warrants it. Choose among supported options using comorbidities, reproductive plans, adverse effects, route and access.
Valproate is an effective option for some adults but reproductive risks substantially restrict its suitability.
- Prevention drugs are not interchangeable rescue medicines.
- Topiramate and valproate require careful reproductive-risk counseling; beta blockers may be unsuitable with bradycardia or bronchospasm.
AAN/AHS · Adult migraine prevention guideline announcement · 2026 ↗
Check your understanding
In a patient with migraine, when should preventive treatment be offered?
A. Any single migraine attack
B. ≥4 monthly migraine days, ≥4 moderate-to-severe headache days, or meaningful functional impairment
C. Only if aura is present
D. Only after an emergency visit
Reveal explanation
≥4 monthly migraine days, ≥4 moderate-to-severe headache days, or meaningful functional impairment
This guidance uses attack frequency and function, not a single-attack trigger.