Therapy of migraine attack and migraine prophylaxis - Recommendations of the German Migraine and Headache Society

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 disturb ances prior to headache. Mild to moderate attacks are treated with antiemet ics (metoclopramide or domperidone) in combination with analgesics (aspirin , paracetamol, ibuprofen, naproxen, diclofenac). Moderate and severe attack s ore treated with 5-HT1B/1D receptor agonists ("triptans"). Ergots in comb ination with antiemetics ore less effective than triptans. Patients with fr equent and severe attacks need medical and non-pharmacological migraine pro phylaxis. Drugs of first choice ore the betablockers metoprolol and propran olol and the calcium channel blocker flunarizine. Drugs of second choice or e valproic acid and non-steroidal antiinflammatory drugs. Nonmedical treatm ent includes relaxation techniques combined with cognitive therapy, stress mamagement and sport therapy.