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EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force

  1. S. Evers1,
  2. J. Áfra2,
  3. A. Frese1,3,
  4. P. J. Goadsby4,5,
  5. M. Linde6,
  6. A. May7,
  7. P. S. Sándor8

Article first published online: 7 AUG 2009

DOI: 10.1111/j.1468-1331.2009.02748.x

Issue

European Journal of Neurology

European Journal of Neurology

Volume 16, Issue 9, pages 968–981, September 2009

Additional Information

How to Cite

Evers, S., Áfra, J., Frese, A., Goadsby, P. J., Linde, M., May, A. and Sándor, P. S. (2009), EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. European Journal of Neurology, 16: 968–981. doi: 10.1111/j.1468-1331.2009.02748.x

Author Information

  1. 1

    Department of Neurology, University of Münster, Münster, Germany

  2. 2

    National Institute of Neurosurgery, Budapest, Hungary

  3. 3

    Academy of Manual Medicine, Münster, Germany

  4. 4

    Headache Group, Department of Neurology, University of California, San Francisco CA, USA

  5. 5

    UCL, Institute of Neurology Queen Square, London, UK

  6. 6

    Cephalea Headache Centre, Läkarhuset Södra vägen, Gothenburg, Sweden

  7. 7

    Department of Neurology, University of Hamburg, Germany

  8. 8

    Department of Neurology, University of Zurich, Switzerland

*S. Evers, Department of Neurology, University of Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany (tel.: +49 251 8348196; fax: +49 251 8348181; e-mail: everss@uni-muenster.de).

Publication History

  1. Issue published online: 7 AUG 2009
  2. Article first published online: 7 AUG 2009
  3. Received 25 March 2009 Accepted 3 June 2009

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Keywords:

  • evidence-based medicine;
  • migraine;
  • prophylaxis;
  • triptans

Background:  Migraine is one of the most frequent disabling neurological conditions with a major impact on the patients’ quality of life.

Objectives:  To give evidence-based or expert recommendations for the different drug treatment procedures in the particular migraine syndromes based on a literature search and the consensus of an expert panel.

Methods:  All available medical reference systems were screened for the range of clinical studies on migraine with and without aura and on migraine-like syndromes. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies (EFNS) resulting in level A, B, or C recommendations and good practice points.

Recommendations:  For the acute treatment of migraine attacks, oral non-steroidal antiinflammatory drug (NSAID) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAID and triptans, oral metoclopramide or domperidone is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. Status migrainosus can be treated by cortoicosteroids, although this is not universally held to be helpful, or dihydroergotamine. For the prophylaxis of migraine, betablockers (propranolol and metoprolol) flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis include amitriptyline, naproxen, petasites, and bisoprolol.

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