The 2026 Taiwan headache society guideline on the use of treatments targeting the CGRP pathway

The introduction of CGRP-targeted therapy has markedly influenced migraine care in Taiwan, together with accumulating evidence and clinical experience. Therefore, the Treatment Guideline Subcommittee of the Taiwan Headache Society updated its 2022 consensus on preventive migraine therapy, with a specific focus on CGRP-targeted therapies. This updated guideline also provides evidence-based recommendations and practical guidance on the use of gepants following their introduction in Taiwan. After reviewing recent clinical trials, meta-analyses, and international guidelines, and integrating expert panel opinions, we developed this new guideline to update the treatment options, recommended populations, timing of initiation and discontinuation, and practical considerations for CGRP-targeted therapy, organised into ten clinical questions. According to the current consensus, preventive treatment is recommended for patients with ≥4 headache days per month, significant disability, failure of or contraindications to acute therapy, complicated migraine with severe aura (such as hemiplegic migraine or migrainous infarction), or when patient preference favours prevention after balancing potential benefits and risks. Currently, CGRP-targeted therapies for migraine prevention include anti-CGRP monoclonal antibodies, namely erenumab, fremanezumab, galcanezumab, and eptinezumab, as well as small-molecule CGRP receptor antagonists, including rimegepant and atogepant. In this 2026 updated guideline, CGRP-targeted therapy is listed as one of the first-line treatment options for both episodic and chronic migraine prevention. A history of failure of multiple preventive medications is not required before initiating CGRP-targeted therapy, as early initiation may provide better migraine control than delayed treatment. For both episodic and chronic migraine, the Taiwan Headache Society recommends that CGRP-targeted therapy may be continued for up to 12 months. This update is crucial for improving migraine care and highlights the importance of continuous CGRP-targeted therapy, rather than premature or unnecessary treatment interruption.