[Treatment of migraine].Dtsch Med Wochenschr. 2007 Oct; 132(41):2153-8.DM
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-HT (1B/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.