Spezifische Therapie der akuten Migräneattacke: Mutterkornalkaloide und Triptane

Zusammenfassung

Diese Arbeit referiert die Ergebnisse kontrollierter Studien zur Therapie akuter Migräneattacken mit spezifischen Migränemitteln wie Mutterkornalkaloiden und Triptanen. Vergleichsstudien sind möglich als direkter Vergleich zweier Substanzen oder basieren auf großen Metaanalysen. Die meisten Studien benutzten eine Besserung der Kopfschmerzen zwei Stunden nach Einnahme des Migränemittels von schwer oder mittelschwer auf leichte oder keine Kopfschmerzen als den primären Zielparameter. Die Internationale Kopfschmerzgesellschaft empfiehlt aber entweder den Endpunkt „schmerzfrei nach zwei Stunden” oder „sustained pain free” zu benutzen (= schmerzfrei nach zwei Stunden, kein Wiederkehrkopfschmerz, keine zusätzliche Medikation). Mittelschwere und schwere Migräneattacken sollten mit spezifischen Migränemitteln behandelt werden. Dabei sind Triptane signifikant wirksamer als Mutterkornalkaloide. Nicht alle Triptane sind gleich wirksam. Sie unterscheiden sich in Wirksamkeit, Häufigkeit des Wiederkehrkopfschmerzes und den Nebenwirkungen.

Abstract

This review summarizes the results of treatment trials with ergots and 5-HT_1B/D-agonists (triptans) for the treatment of acute migraine attacks. A comparison between anti-migraine drugs is only possible in randomized controlled trials (RCTs) with head-to-head comparisons. Another way to indirectly compare the different triptans is a meta-analysis. The primary endpoint in most headache trials is the improvement from severe or moderate head pain to mild or no pain after 2 hours. The most recent recommendations of the International Headache Society, however, propose 2 hour pain free and 24 hours sustained pain free (pain free after 2 hours, no rescue medication, and no recurrence) as the appropriate endpoints for clinical trials in migraine treatment. Moderate or severe migraine attacks should be treated with specific migraine drugs. These include ergot alkaloids (also called ergots) and triptans. The efficacy of ergots is lower than that of the triptans. Not all triptans are the same. Differences can be shown for efficacy, recurrence rates and side effects.

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