Therapy of Migraine Attacks and Migraine Prophylaxis Recommendations of the German Society for Neurology and the German Migraine and Headache Society

• Triptans (5-HT1B/1D-agonists) perform better if they are taken at the start of a migraine attack, as long as the headache is of mild or moderate intensity (⇑⇑). This recommendation to take triptans if the headache is mild only applies for patients who can differentiate migraine attacks from tension headaches. • The presence of allodynia (touch is perceived as painful) in the area of the face and head during a migraine attack may predict a lower efficacy (⇑). • Zolmitriptan is available as 5 mg nasal spray. This application acts more rapidly than the oral form (⇑). • Sumatriptan is available as a tablet disolving rapidly in the gastrointestinal tract. Whether efficacy occurs more rapidly than is the case with normal tablets is not known (⇔). • Ergotamine as a monosubstance is available only as a 2 mg tablet. • The combination of acetylsalicylic acid, paracetamol (acetaminophen) and caffeine is more effective than the combination without caffeine and more effective than the substances given alone (⇑⇑). • Acetylsalicylic acid in soluble buffered form (1000 mg) is comparable in effectiveness with 400 mg ibuprofen and 50 mg sumatriptan (⇑⇑). • COX-2 inhibitors have a similar effectiveness as ibuprofen or sumatriptan in the therapy of migraine attacks (⇑). Up to now none of the COX-2 inhibitors coxibs has been approved for the treatment of migraine attacks. Considering the risk of vascular events in long-term use they can not be recommended for the treatment of migraine attacks.