RSS-Feed abonnieren
DOI: 10.1055/s-2007-985657
© Georg Thieme Verlag KG Stuttgart · New York
Aktuelle Therapie der Migräne
Treatment of migrainePublikationsverlauf
eingereicht: 13.6.2007
akzeptiert: 9.8.2007
Publikationsdatum:
08. Oktober 2007 (online)
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-HT1B/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-HT1B/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
Literatur
- 1 Ashkenazi A, Silberstein S, Jakubowski M. et al . Improved identification of allodynic migraine patients using a questionnaire. Cephalalgia. 2007; 27 325-329
- 2 Brandes J L, Saper J R, Dianond M. et al . Topiramate for migraine prevention. A randomized controlled trial. JAMA. 2004; 291 965-73
- 3 Burstein R, Yarnitsky D, Goor-Aryeh I. et al . An association between migraine and cutaneous allodynia. Ann Neurol. 2000; 47 614-624
- 4 Burstein R. Deconstructing migraine headache into peripheral and central sensitization. Pain. 2001; 89 107-110
- 5 Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: a race against the development of Cutaneous Allodynia. Ann Neurol. 2004; 55 19-26
- 6 Diener H C. Efficacy and safety of intravenous acetylsalicylic acid lysinate compared to subcutaneous sumatriptan and parenteral placebo in the acute treatment of migraine. A double-blind, double-dummy, randomized, multicenter, parallel group study. The ASASUMAMIG Study Group. Cephalalgia. 1999; 19 581-588
- 7 Diener H C, Tfelt-Hansen P, Dahlöf C. et al . Topiramate in migraine prophylaxis - results from a placebo controlled trial with propranolol as an active control. J Neurol. 2004; 251 943-50
- 8 Ferrari M D, Roon K I, Lipton R B. et al . Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: a meta analysis of 53 trials. Lancet. 2001; 358 1668-75
- 9 Giffin N J, Ruggiero L, Lipton R B. et al . Premonitory symptoms in migraine: an electronic diary study. Neurology. 2003; 60 935-940
- 10 Goadsby P J, Lipton R B, Ferrari M D. Migraine - current understanding and treatment. N Engl J Med. 2002; 346 257-270
- 11 Goadsby P J, Vila C. on behalf of the ACT study group . „Act when mild”: early vs. non-early Almotriptan intervention in migraine. Cephalalgia. 2006; 26 1393-1394
- 12 Headache Classification Subcommittee of the International Headache Society . The International Classification of Headache Disorders. Cephalalgia. 2004; 24 Suppl 1 1-151
- 13 Holroyd K A, Penzien D B, Cordingley G E. Propranolol in the management of recurrent migraine: a meta-analytic review. Headache. 1991; 31 333-40
- 14 Krymchantowski A V, Barbosa J S. Rizatriptan combined with rofecoxib vs. rizatriptan for the acute treatment of migraine: an open label pilot study. Cephalalgia. 2002; 22 309-12
- 15 Krymchantowski A V. Acute treatment of migraine. Breaking the paradigm of monotherapy. BMC Neurol. 2004; 4 4
- 16 Lampl C, Katsarava Z, Diener H C. et al . Lamotrigine reduces migraine aura and migraine attacks in patients with migraine with aura. J Neurol Neurosurg Psychiatry. 2005; 76 1730-1732
- 17 Leinisch E, Evers S, Kaempfe N. et al . Evaluation of the efficacy of intravenous acetaminophen in the treatment of acute migraine attacks: a double-blind, placebo-controlled parallel group multicenter study. Pain. 2005; 117 396-400
- 18 Olesen J, Diener H C, Schoenen J. et al . No effect of eletriptan administration during the aura phase of migraine. Eur J Neurol. 2004; 11 671-7
- 19 Pietrobon D, Striessnig J. Neurobiology of migraine. Nat Rev. 2003; 4 386-398
- 20 Rapoport A M, Bigal M E. Preventive migraine therapy: what is new. Neurol Sci. 2004; 25 S177-S185
- 21 Schrader H, Stovner L J, Helde G. et al . Prophylactic treatment of migraine with angiotensin converting enzyme inhibitor (Lisinopril): randomized, placebo-controlled, crossover study. Brit Med J. 2001; 322 1-5
- 22 Shields K G, Goadsby P J. Propranolol modulates trigeminovascular responses in thalamic ventroposteromedial nucleus: a role in migraine?. Brain. 2005; 128 86-97
- 23 Silberstein S D. Preventive treatment of migraine. Trends Pharmacol Sci. 2006; 27 410-415
- 24 Silberstein S D, Lipton R B, Dodick D W. et al . Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind placebo-controlled trial. Headache. 2007; 47 170-80
- 25 Steiner T J, Findley L J, Yuen A WC. Lamotrigine versus placebo in the prophylaxis of migraine with and without aura. Cephalalgia. 1997; 17 109-12
- 26 Trovnik E, Stovner L J, Helde G. et al . Prophylactic treatment of migraine with an angiotensin II receptor blocker. J Am Med Ass. 2003; 289 65-69
PD Dr. Uwe Reuter
Charité Universitätsmedizin Berlin, Neurologische Klinik und Poliklinik
Charitéplatz 1
10117 Berlin
Telefon: 030/450-560 274
Fax: 030/450-560 932
eMail: uwe.reuter@charite.de