Therapy of migraine attacks and migraine prophylaxis - Recommendations by the German Society for Migraine and Headache (DMKG)

The incidence of migraine is 6-8% for men and 12-14% for women. Migraine at tacks lead to pulsating and throbbing hemicrania with autonomic disturbance s. Up to 15 % of patients suffer from migraine with aura with visual distur bances prior to headache. Mild to moderate attacks are treated with antieme tics (metoclopramide or domperidone) in combination with analgesics (aspiri n, paracetamol, ibuprofen, naproxen, diclofenac). Moderate and severe attac ks are treated with 5-HT1B/1D receptor agonists ("triptans"). Ergots in com bination with antiemetics are less effective than triptans. Patients with f requent and severe attacks need medical and non-pharmacological migraine pr ophylaxis. Drugs of first choice are the beta-blockers metoprolol and propr anolol and the calcium channel blocker flunarizine. Drugs of second choice are valproic acid and non-steroidal antiinflammatory drugs. Nonmedical trea tment includes relaxation techniques combined with cognitive therapy, stres s management and sports therapy.