Praxistipps Migräneprophylaxe

Patientinnen und Patienten mit häufigen und schweren Migräneattacken benötigen eine medikamentöse und nicht medikamentöse Migräneprophylaxe. Trotz einer Vielzahl kontrollierter randomisierter Studien, die unterschiedliche Ansätze zur Migräneprophylaxe untersuchen, bleiben im klinischen Alltag viele Fragen zum Management von Migränepatienten offen. Daher hat die Internationale Kopfschmerzgesellschaft (IHS) entschieden, für diese Fragen Praxisempfehlungen, beruhend auf Beobachtungsstudien und Expertenkonsens, zu formulieren.

Kernaussagen

• Indikation: Eine medikamentöse Prophylaxe ist angezeigt bei ≥ 4 Migränetagen pro Monat und relevanter Beeinträchtigung der Lebensqualität.

• Ziel: Therapieerfolg ist definiert als ≥ 50% Reduktion der Migränetage (episodisch) bzw. ≥ 30% (chronisch) oder eine relevante subjektive Verbesserung.

• Therapieentscheidung: Erfolgt gemeinsam mit dem Patienten – individuelle Präferenzen, Erwartungen und Komorbiditäten müssen berücksichtigt werden.

• CGRP-Antikörper: wirken schneller und sind oft besser verträglich als klassische orale Prophylaktika; auch Spätresponder sind möglich.

• Therapiebeurteilung: üblicherweise nach 3 Monaten, bei quartalsweiser Gabe nach 6 Monaten – ggf. längere Beobachtung sinnvoll.

• Therapiewechsel: Bei Nichtansprechen kann ein Wechsel innerhalb der Substanzklassen (z.B. CGRP-Antikörper ↔ Gepante) wirksam sein.

• Kombinationen: Kombinationstherapien sind möglich, aber derzeit nicht standardisiert oder ausreichend untersucht.

• Dauer: mindestens 6–12 Monate; bei chronischer Migräne oder Komorbiditäten auch länger – regelmäßige Reevaluation empfohlen.

• Besondere Gruppen: Schwangerschaft, Stillzeit, Kinder, ältere Patienten und Komorbiditäten erfordern individualisierte Therapieansätze.

Schlüsselwörter

Migräneprophylaxe - CGRP-Antikörper - Komorbiditäten - Migräneattacke - chronische Migräne

Publication History

Article published online:
19 September 2025

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