EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force.
BACKGROUND
Migraine is one of the most frequent disabling neurological conditions with a major impact on the patients' quality of life.


OBJECTIVE
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.


CONCLUSIONS
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.
Evers
S
S
Department of Neurology, University of Münster, Münster, Germany. everss@uni-muenster.de
Afra
J
J
Frese
A
A
Goadsby
P J
PJ
Linde
M
M
May
A
A
Sándor
P S
PS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000700:Analgesics; D000927:Anticonvulsants; D000932:Antiemetics; D002121:Calcium Channel Blockers; D017366:Serotonin Receptor Agonists