Aktuelle Therapie der Migräne

Zusammenfassung

Die Migräne ist gekennzeichnet durch einen attackenförmig auftretenden, meist einseitigen und pulsierenden Kopfschmerz, der mit vegetativen Begleitsymptomen einhergeht. Bei ca. 15 % der Patienten kommt es zusätzlich zu, meist visuellen, transienten fokal-neurologischen Defiziten, der sog. Migräne-Aura.

Migräneattacken von leichter und mittlerer Intensität sollten zunächst mit nicht-steroidalen Antirheumatika (NSAR), ggf. in Kombination mit einem prokinetischen Antiemetikum wie Metoclopramid oder Domperidon, behandelt werden. Bei schweren Attacken und/oder nicht ausreichender Wirkung sollten 5-HT_1B/1D-Rezeptoragonisten (Triptane) eingesetzt werden.

Bei Patienten mit besonders häufigen, sehr langen oder komplizierten Migräneattacken sollte eine medikamentöse Prophylaxe verwendet werden. Substanzen erster Wahl sind hierfür Betablocker (Propranolol und Metoprolol), Topiramat und Flunarizin. Diese sollten in ausreichender Dosierung über mindestens 6 - 12 Monate eingesetzt werden.

Abstract: Treatment of migraine

Migraine attacks are characterized as unilateral and pulsating headache with autonomic features. In about 15 % of Migraine patients the attacks are accompanied by, mostly visual, transient focal neurologic disturbances, the migraine aura.

Migraine attacks of mild or moderate intensity should initially be treated with non-steroidal anti-inflammatory drugs (NSAID). A combination with prokinetic and antiemetic drugs like metoclopramide or domperidone has proved to relieve nausea and increase efficacy of the analgesic drugs. In case of severe attacks or lack of treatment efficacy the migraine attacks should be treated with 5-HT_1B/1D receptor agonists (triptans).

Patients that suffer under very frequent and/or very severe migraine attacks should receive a prophylactic treatment. Prophylactic drugs of first choice are Betablockers (Propranolol and Metoprolol), Topiramate and Flunarizine. Prophylactic treatment should be administered over a period of at least 6 - 12 months.

Schlüsselwörter

Migräne - Prophylaxe - nicht-steroidale Antirheumatika - NSAR - Triptane

Key words

migraine - non-steroidal anti-inflammatory drugs - NSAID - prophylaxis - triptans

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