A global comparison of clinical guidelines for the diagnosis and management of migraine: similarities, differences, and gaps.

PURPOSE OF REVIEW: To compare international clinical guidelines for migraine diagnosis and management, identifying consensus, differences, and gaps. RECENT FINDINGS: Assessed guideline repositories and society websites from 2012 to 2025 for recommendations from American, British, Italian, Japanese, French, and International Headache Society (IHS) guidelines. All guidelines base diagnosis on International Classification of Headache Disorders (ICHD-3) and recommend early acute therapy with analgesics and NSAIDs. Triptans are universally endorsed for moderate-to-severe attacks, while gepants and ditans appear in newer guidelines but remain inaccessible in many countries. Preventive therapy is advised for frequent or disabling attacks; recommended first-line agents include beta-blockers (propranolol), antiseizure medications (ASMs) (topiramate, valproate), and tricyclic antidepressants (amitriptyline). Calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants are positioned as first-line by American and Japanese guidelines but restricted in Britain and France. OnabotulinumtoxinA is reserved for chronic migraine after several failed oral preventives. Nonpharmacological interventions such as neuromodulation and behavioral therapies are increasingly incorporated. Differences stem primarily from drug availability and insurance coverage. Evidence gaps persist for pediatric, geriatric, and pregnant populations and long-term safety of emerging therapies. SUMMARY: Despite shared principles, migraine guidelines diverge in thresholds and access to newer treatments; global collaboration is needed to address gaps and ensure equitable care. This review provides a global perspective overall.