Advances in pharmacological treatment of migraine

Migraine is a paroxysmal disorder with attacks of headache, nausea, vomitin g, photo- and phonophobia and malaise. This review summarises new treatment options both for the therapy of the acute attack as well as for migraine p rophylaxis. Analgesics like aspirin or non-steroidal anti-inflammatory drug s (NSAIDs) are effective in treating migraine attacks. Few controlled trial s were performed for the use of ergotamine or dihydroergotamine. These tria ls indicate inferior efficacy compared with serotonin (5-HT1B/D) agonists ( triptans). The triptans (almotriptan, eletriptan, frovatriptan, naratriptan , rizatriptan, sumatriptan and zolmitriptan), are highly effective. They im prove headache as well as nausea, photo- and phonophobia. The different tri ptans show only minor differences in efficacy, headache recurrence and adve rse effects. The knowledge of their different pharmacological profile allow s a more specific treatment of the individual migraine characteristics. Mig raine prophylaxis is recommended, when more than three attacks occur per mo nth, if attacks do riot respond to acute treatment or if side effects of ac ute treatment are severe. Substances with proven efficacy include the beta- blockers metoprolol and propranolol, the calcium channel blocker flunarizin e, several 5-HT antagonists and amitriptyline. Recently anti-epileptic drug s (valproic acid, gabapentin, topiramate) were evaluated for the prophylaxi s of migraine. The use of botulinum toxin is under investigation.