[Prophylactic drug management of migraine].
Migraine prophylaxis with drugs is still an essential part of migraine therapy. This is especially true for those patients with frequent migraines who are in danger of developing drug-induced headaches. Migraine prophylaxis should be taken in consideration in patients who suffer from 7 or more migraine days per month in spite of all non-pharmacological efforts. When choosing a prophylactic drug not only efficacy but tolerability and safety for long-term intake should be considered. Prophylactic drugs used to be classified as drugs of first, second and third choice. According to this step care model treatment was started with a drug of first choice and only in case of lack of efficacy or adverse events a drug of lower choice was selected. Today, in contrast to the traditional step care a stratified care is favored. Treatment is individualized based on an assessment of the patients' medical needs, on comorbidity, the migraine phenotype and most importantly the individual situation of the patient in life. The paper gives an overview of the efficacy and tolerability of drugs used in migraine prophylaxis.
Göbel
H
H
Neurologisch-verhaltensmedizinische Schmerzklinik Kiel and Universität Kiel. kiel@Schmerzklinik.de
Heinze
A
A
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use; D019091:Critical Pathways; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D008134:Long-Term Care; D008274:Magnesium / Q000009:adverse effects / Q000627:therapeutic use; D008881:Migraine Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017366:Serotonin Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D002121:Calcium Channel Blockers; D017366:Serotonin Receptor Agonists; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D008274:Magnesium