Recent advances in the treatment of headaches.
OBJECTIVE
In past years, important advances have been made in the treatment of idiopathic headache disorders. New controlled trials have been published for the acute and the prophylactic drug and non-drug therapies. Furthermore, new headache entities have been described by the International Headache Society for which treatment recommendations can be given.


RESULTS
Triptans and non-steroidal anti-inflammatory drugs are still the drugs of first choice for the treatment of migraine attacks. Recent studies show that early treatment is clearly effective in migraine and that differential therapy with triptans can be helpful. New drugs with new mechanisms are being developed such as a calcitonin gene-related peptide antagonist. For the prophylaxis of migraine, topiramate has been introduced as an effective new drug. Botulinum toxin did not show convincing evidence of efficacy in migraine and tension-type headache. For migraine and cluster headache, surgical procedures such as the closure of the patent foramen ovale (migraine) and neurostimulation of the hypothalamus (cluster headache) are also under evaluation. A group of miscellaneous headaches (group 4 of the International Headache Society classification) is also described, for which treatment recommendations, in particular indomethacin in most cases, can now be given although no placebo-controlled trials have been performed.


CONCLUSIONS
Recent advances in headache treatment comprise growing evidence for an appropriate drug administration and for differential drug therapy rather than the development of new drugs or procedures. Surgical and other non-drug treatment procedures are under discussion and might be an additional tool for headache treatment in future years.
Department of Neurology, University of Münster, Münster, Germany. everss@uni-muenster.de
Stefan
S
Evers
Achim
A
Frese