Akuttherapie und Prophylaxe der Migräne

 

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Zusammenfassung

Die Deutsche Migräne- und Kopfschmerzgesellschaft und die Deutsche Gesellschaft für Neurologie legen eine revidierte Fassung ihrer gemeinsamen evidenzbasierten Leitlinie für die Therapie der Migräne vor. Zur Akuttherapie der leichten Migräneattacke wird die frühzeitige und hochdosierte Einnahme von NSAR oder von Paracetamol empfohlen. Bei schweren Migräneattacken wird die Einnahme eines Triptans empfohlen, eine generelle Präferenz für eine bestimmte Substanz wird hierbei nicht ausgesprochen. Zur medikamentösen Prophylaxe der Migräne werden als Substanzen der ersten Wahl Metoprolol, Propranolol, Flunarizin, Valproinsäure und Topiramat empfohlen. Substanzen der zweiten Wahl sind Amitriptylin, Venlafaxin, Gabapentin, Naproxen, Acetylsalicylsäure, Pestwurz, Magnesium und Vitamin B₂. Im Mittelpunkt der nicht medikamentösen Behandlung der Migräne stehen neben Empfehlungen zur Lebensführung, Entspannungsverfahren (progressive Muskelrelaxation), Biofeedbackverfahren und kognitive Verhaltenstherapie. Gerade die Kombination von nicht medikamentösen Verfahren untereinander oder mit einer medikamentösen Prophylaxe ist besonders wirksam.

Summary

The German Migraine and Headache Society and the German Neurological Society present the revised version of their evidence-based guidelines for the treatment of migraine. In the treatment of mild attacks, the early intake of NSAIDs or paracetamol and in severe attacks the intake of a triptan is recommended. There is no general preference for a specific triptan. In the drug prophylaxis of migraine, substances of first choice are metoprolol, propranolol, flunarizine, valproic acid, and topiramate. Substances of second choice are amitriptyline, venlafaxine, gabapentin, naproxen, acetylsalicylic acid, petasites, magnesium, and vitamine B₂. Beside advices for life-style, relaxation therapy, biofeedback and cognitive behavioral therapy are the focus of non-drug treatment procedures. In particular, the combination of non-drug therapies among themselves or with a drug prophylaxis are most effective.

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