This is a Continuing Medical Education article, and can be found with corresponding questions on the internet at http://www.efns.org/content.php?pid=132. Certificates for correctly answering the questions will be issued by the EFNS
EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force
Article first published online: 7 AUG 2009
© 2009 The Author(s). Journal compilation © 2009 EFNS
European Journal of Neurology
Volume 16, Issue 9, pages 968–981, September 2009
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
This is a Continuing Medical Education article, and can be found with corresponding questions on the internet at http://www.efns.org/content.php?pid=132. Certificates for correctly answering the questions will be issued by the EFNS.
- Issue published online: 7 AUG 2009
- Article first published online: 7 AUG 2009
- Received 25 March 2009 Accepted 3 June 2009
- evidence-based medicine;
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.