EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force

Abstract

Background: Migraine is one of the most frequent disabling neurological conditions with a major impact on the patientsÕ quality of life. Objectives: To give evidence-based or expert recommendations for the different drug treatment procedures in the particular migraine syndromes based on a literature search and the consensus of an expert panel. Methods: All available medical reference systems were screened for the range of clinical studies on migraine with and without aura and on migraine-like syndromes. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies (EFNS) resulting in level A, B, or C recommendations and good practice points. Recommendations: For the acute treatment of migraine attacks, oral non-steroidal antiinflammatory drug (NSAID) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAID and triptans, oral metoclopramide or domperidone is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. Status migrainosus can be treated by cortoicosteroids, although this is not universally held to be helpful, or dihydroergotamine. For the prophylaxis of migraine, betablockers (propranolol and metoprolol) flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis include amitriptyline, naproxen, petasites, and bisoprolol.

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

“…21,22 In clinical practice, physicians and patients choose preventive treatments based primarily on FDA approval and drug tolerability. 9,18,19,[23][24][25] Systematic reviews and meta-analyses with consistent and transparent appraisal of study quality and strength of evidence are essential for arriving at evidence-based migraine preventive treatment and policy decisions. 26 Previously published systematic reviews focused on the efficacy of specific drugs rather than comparative effectiveness and tolerability of all pharmacologic options.…”

General Issues Arising from the Use of Drugs for Headache Disorders

“…Even when a correct diagnosis has been made, undertreatment and mismanagement have been observed despite the existence of guidelines for clinical practice (May et al 2006;Steiner et al 2007;Evers et al 2009). Patients may receive acute treatment, but no prevention (when indicated) and vice versa.…”

A Vascular Approach to Glaucoma

“…Migraine treatment is not only related to pain control but also to the use of vasoactive substances. Prophylaxis of migraine attacks can be achieved by the administration of beta-blockers, which act via a mechanism thought to down regulate the serotonergic and beta-receptor activity involved in initiating the attacks (Evers, 2006). Acute migraine treatment, however, involves drugs with powerful vasoconstrictive activity, such as ergot derivates and triptans (Silberstein, 2000).…”