Pharmacological Approaches to Migraine

  • H.-Ch. Diener
Part of the Journal of Neural Transmission. Supplementa book series (NEURAL SUPPL, volume 64)


Migraine is a paroxysmal disorder with attacks of headache, nausea, vomiting, photo-and phonophobia and malaise. This review summarises new treatment options both for the therapy of the acute attack as well as for migraine prophylaxis. Analgesics like aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) are effective in treating migraine attacks. Few controlled trials were perfomed for the use of ergotamine or dihydroergotamine. These trials indicate inferior efficacy compared to serotonin (5-HT)1B/D-agonists (further on called “triptans”). The triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan) are highly effective. They improve headache as well as nausea, photo-and phono-phobia. The different triptans have minor differences in efficacy, headache recurrence and adverse effects. The knowledge of their different pharmacological profile allows a more specific treatment of the individual migraine characteristics. Migraine prophylaxis is recommended, when more than 3 attacks occur per month, if attacks do not respond to acute treatment or if side effects of acute treatment are severe. Substances with proven efficacy include the beta-blockers metoprolol and propranolol, the calcium channel blocker flunarizine, several 5-HT antagonists and amitriptyline. Recently antiepileptic drugs (valproic acid, gabapentin, topiramate) were evaluated for the prophylaxis of migraine. The use of botulinum-toxin is under investigation.


Acute Treatment Migraine Attack Menstrual Migraine Headache Recurrence Migraine Prophylaxis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag/Wien 2003

Authors and Affiliations

  • H.-Ch. Diener
    • 1
  1. 1.Department of NeurologyUniversity EssenFederalRepublic of Germany

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