What’s new

1. 31 August 2026MigraineAmerican Academy of Neurology · American Headache Society

   NewWhen should migraine prevention be offered? New US guideline

   The American Academy of Neurology and the American Headache Society updated their guideline on preventive medicines for migraine in adults, the first update since 2012.

   What changed

   • Prevention should be offered to people with four or more migraine days a month, four or more moderate-to-severe headache days a month, or migraine that gets in the way of work and daily life.
   • Newer medicines, the CGRP antibodies given by injection monthly or every three months and atogepant taken by mouth, now sit alongside older medicines among the options with high or moderate confidence in the evidence.
   • A medicine should be judged after 8 to 12 weeks at the right dose; Botox for chronic migraine after 24 weeks.
   • For anyone who could become pregnant: valproate and topiramate should be avoided where possible because of the risk to a baby. Topiramate above 200 mg a day can make hormonal contraception less reliable.

   What this means for you

   • If your attacks are frequent or disrupt your days, prevention is worth asking about.
   • If one medicine doesn’t work, a different type may.
   • Give a medicine two to three months before judging it, unless the side effects are troublesome.

   What it doesn’t mean

   • It doesn’t mean the newer medicines suit everyone, or that you should stop one that works for you.
   • This is a US guideline; which medicines are available and covered differs between countries.

   Read also: Migraine and attack triggers
   Source: Potrebic S, Tanveer S, Becker WJ, et al. Pharmacologic treatment for migraine prevention in adults: practice guideline recommendations. Neurology 2026;107(7):e214881. doi.org/10.1212/WNL.0000000000214881

2. 27 August 2026StrokeAmerican Heart Association · American Stroke Association

   NewRehabilitation after stroke: a new US guideline, from hospital to home

   The American Heart Association and American Stroke Association published a new guideline on rehabilitation for adults after stroke, replacing the 2016 version.

   What changed

   • Rehabilitation starts in hospital once the person is stable, with gradual steps in the first two days: sitting up, sitting on the edge of the bed, then standing and walking.
   • Strenuous exercise is avoided in the first 24 hours, especially after a bleed or a severe stroke.
   • Regular screening for depression and anxiety is part of rehabilitation, because both are common and slow recovery.
   • Families have a clear place: education, support and a part in the plan. Rehabilitation at home or by video is a reasonable alternative when a clinic is hard to reach.

   What this means for you

   • Ask the team: what can your relative safely do today, and how can you help?
   • Recovery continues after leaving hospital; walking and everyday movement at home are part of the treatment.
   • If your relative’s mood changes or they lose interest in things, tell the doctor; it can be treated.

   What it doesn’t mean

   • It doesn’t mean the person should get up before the team says so.
   • This is a US guideline; the services available differ between countries.

   Read also: Stroke: the first hours
   Source: Richards LG, et al. 2026 Guideline for adult stroke rehabilitation and recovery. Stroke 2026. doi.org/10.1161/STR.0000000000000536

3. 26 January 2026StrokeAmerican Heart Association · American Stroke Association

   NewStroke: a wider treatment window, and getting there fast still matters most

   The American Heart Association and American Stroke Association published a new guideline on treating ischaemic stroke in its first hours, replacing the 2018 guideline. For the first time it includes recommendations for stroke in children.

   What changed

   • Clot-dissolving treatment through a vein within 4.5 hours, with alteplase or tenecteplase. Tenecteplase is a single injection instead of an hour-long drip.
   • For some patients, treatment is possible later: clot-dissolving up to 9 hours or when the time of onset is unknown, and clot removal through a catheter up to 24 hours, if scans show brain that can still be saved.
   • Clot removal is now an option for some people with fairly large strokes, and for blockage of the basilar artery at the back of the brain.
   • Ambulances equipped with a CT scanner (mobile stroke units) are recommended where available.
   • For the first time: warning signs of stroke in children, and clot removal or clot-dissolving treatment for selected children.

   What this means for you

   • Don’t decide for yourself that it’s too late. Call an ambulance even if hours have passed.
   • Note the last time the person was seen well; it is the single most useful fact for the team.
   • Don’t drive yourself, and don’t wait to see whether the symptoms pass.
   • Children have strokes too. Call an ambulance for a child with a sudden severe headache with vomiting and sleepiness, a new seizure on one side of the body, or sudden trouble with speech, vision, walking or balance.

   What it doesn’t mean

   • It doesn’t mean everyone can be treated up to 24 hours; that depends on scans and the person’s condition, and arriving earlier means more options.
   • It doesn’t mean every hospital offers every treatment; some need a specialist centre, and the ambulance team knows where to take you.

   Read also: Stroke: the first hours
   Source: Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the early management of patients with acute ischemic stroke. Stroke 2026. doi.org/10.1161/STR.0000000000000513

4. 23 April 2025EpilepsyInternational League Against Epilepsy (ILAE)

   New names for seizure types

   The International League Against Epilepsy updated how epileptic seizures are classified, the first update since 2017.

   What changed

   • Four main classes: focal, generalised, unknown (focal or generalised), and unclassified. The number of seizure types fell from 63 to 21.
   • The level of consciousness during a seizure is now described with one word, consciousness, which combines awareness and responsiveness.
   • Seizures are described by the order of what happens in them, not just the first sign.

   What this means for you

   • A new report may use a different name for seizures that haven’t changed. The name changed, not the illness.
   • Describing what you saw in order, what happened first and what came next, matters more than ever. A video is still the best thing to bring.

   What it doesn’t mean

   • It doesn’t automatically change a diagnosis or a medicine.

   Read also: Seizure in front of you? Here’s what to do
   Source: Updated classification of epileptic seizures: position paper of the International League Against Epilepsy. Epilepsia 2025. doi.org/10.1111/epi.18338

5. 21 October 2024StrokeAmerican Heart Association · American Stroke Association

   Preventing a first stroke: a guideline that includes women’s health and pregnancy

   The American Heart Association updated its guideline on preventing stroke in people who have never had one, replacing the 2014 version.

   What changed

   • It is built around eight factors for heart and brain health: blood pressure, blood sugar, cholesterol, weight, sleep, physical activity, diet and smoking.
   • It adds recommendations specific to women, including preventing stroke related to pregnancy.
   • It supports a Mediterranean-style diet and regular physical activity, and mentions GLP-1 medicines for people with diabetes at high stroke risk.

   What this means for you

   • Most strokes can be prevented. Know your numbers: blood pressure, sugar and cholesterol.
   • If you had complications in pregnancy, such as high blood pressure, tell your doctor, even years later.

   What it doesn’t mean

   • It doesn’t mean stroke can never happen to someone who follows every recommendation, but the risk falls clearly.

   Read also: Stroke in “Medical language”
   Source: Bushnell C, et al. 2024 Guideline for the primary prevention of stroke. Stroke 2024. doi.org/10.1161/STR.0000000000000475

6. 20 June 2024Medicines and pregnancyUK Medicines and Healthcare products Regulatory Agency (MHRA)

   Topiramate and pregnancy: a UK pregnancy prevention programme

   The UK medicines regulator introduced a pregnancy prevention programme for every woman or girl who could become pregnant and takes topiramate, a medicine used for epilepsy and migraine.

   What changed

   • Before starting: highly effective contraception, a negative pregnancy test, and an understanding of the risks.
   • It should not be used in pregnancy to prevent migraine, and for epilepsy only if there is no suitable alternative.
   • The reason: a large study of about 4.5 million children linked exposure in the womb with a higher risk of autism, developmental disorders and learning difficulties, on top of a known risk of birth defects.

   What this means for you

   • If you take topiramate and could become pregnant, ask your doctor for a review of contraception and alternatives.
   • If you take it for epilepsy, don’t stop it suddenly; stopping an epilepsy medicine abruptly can cause dangerous seizures.

   What it doesn’t mean

   • The decision is British, but the risk to a baby is the same everywhere.

   Read also: Migraine and hormonal changes
   Source: MHRA Drug Safety Update: topiramate (Topamax), introduction of new safety measures including a Pregnancy Prevention Programme. June 2024. pharmaceutical-journal.com/article/news/mhra-introduces-new-safety-measures-for-use-of-topiramate-in-pregnancy

For clinicians: the technical detail of these guidelines is on The Tract · Updates. This page was last reviewed on 9 October 2026.