Abstract
If migraine attacks occur more frequently than 2 times a month, treatment of the acute attack with analgesics and ergotamine becomes problematic. An acute relief of migraine symptoms will be achieved only at the risk of developing a drug-induced chronic headache. Therefore, if migraine attacks occur frequently prophylactic treatment should be considered. A bewildering variety of drugs have been discussed for migraine prophylaxis in the past few decades. Only a few of them can be accepted to be effective on the basis of reliable clinical studies. Others have failed to show any superiority to placebo treatment when tested in controlled drug trials for a period long enough to rule out the placebo response, which may simulate effectiveness at the beginning of the trial. The efficacy of metoprolol and propranolol has been demonstrated beyond any doubt. It seems, however, that other β-blocking drugs are less effective or even ineffective. In more than 20% of patients even prolonged treatment with metoprolol or propranolol does not provide sufficient relief. Flunarizine may be tried in these patients, as long as side effects do not occur or can be tolerated by the patient. Whether non-steroidal antirheumatics and dihydroergotamine can be considered as an effective and safe alternative in migraine prophylaxis is still not well established. There is, however, convincing evidence that neither clonidine, nor anti-histamines, nor barbiturates, nor antiepileptic drugs, nor anxiolytics are effective in the prophylactic treatment of migraine. Successful prophylactic treatment cannot be achieved by drug therapy alone. Any form of drug treatment should be complemented by providing the patient with detailed information about the nature of the disease and the properties of the prescribed drugs, as well as careful investigation of the patient's situation and habits and a careful search for precipitants, combined with an attempt to change the patient's habits and to avoid factors that trigger the attacks.
Zusammenfassung
Die Behandlung des Migräneanfalls mit Analgetika oder Ergotamin wird dann problematisch, wenn mehr als 2–3 Anfälle pro Monat auftreten. Bei dieser Konstellation ist die erfolgreiche Behandlung der Symptome mit dem Risiko der Entwicklung eines Dauerkopfschmerzes verbunden. Es muß daher unter dieser Bedingung eine prophylaktische Therapie in Betracht gezogen werden. Eine Unzahl von Substanzen ist in der Vergangenheit versucvhsweise zur prophylaktischen Behandlung eingesetzt worden. Nur ganz wenige haben sich als tatsächlich wirksam erwiesen, wohingegen andere wirkungslos waren, wenn sie in kontrollierten Untersuchungen geprüft wurden, die über einen genügend langen Zeitraum ausgedehnt wurden, um den bei den meisten Untersuchungen initial sehrprominenten Plazeboeffekt auszuschließen. Metoprolol und Propranolol sind wirksame Migräneprophylaktika. Andere β-Blocker dagegen sind wirkungslos. Flunarizin ist eine Alternative, die gelegentlich zu Nebenwirkungen Anlaß gibt, die einen Therapieabbruch erforderlich machen. Ob sich Wirkstoffe aus der Gruppe der Nicht-steroidalen-Antirheumatika oder Dihydroergotamin als Migräneprophylaktika tatsächlich eignen, läßt sich beim derzeitigen Wissensstand nicht entscheiden. Dagegen scheint es sicher zu sein, daß weder Clonidin, Antihistaminika, Barbiturate, Anxiolytika und Antiepileptika bei dieser Indikation von Nutzen sind. Eine erfolgreiche Prophylaxe kann jedoch alleine mit pharmakotherapeutischen Maßnahmen nicht erreicht werden. Eine umfassende Aufklärung des Patienten über sein Leiden und die Eigenschaften der verschriebenen (und der in der Selbstmedikation angewandten) Arzneimittel sowie eine sorgfältige Erkundung der Lebensgewohnheiten und die intensive Suche nach Auslösern für einen Anfall sollten den therapeutischen Ansatz vervollständigen.
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Diener, H.C., Ziegler, A. Medikamentöse Migräneprophylaxe. Schmerz 3, 227–232 (1989). https://doi.org/10.1007/BF02527386
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DOI: https://doi.org/10.1007/BF02527386