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Background Most migraine patients need an effective acute medication. Real-world data can provide important information on the performance of acute migraine medication in clinical practice. Methods We used data from the German Migraine and Headache Society Headache Registry, where patients rate efficacy and tolerability of and satisfaction with each of their acute headache medications. Results A total of 1756 adult migraine patients (females: 85%, age: 39.5 ± 12.8 years, headache days per month: 13.5 ± 8.1) were included. Of these, 93% used acute medication, most frequently triptans (59.3%) and/or non-opioid analgesics (56.4%), and 58.5% rated efficacy as good or very good. This was more frequent for triptans (75.4%) than for non-opioid analgesics (43.6%, p Conclusion In the present population recruited at specialized headache centers, patients rated triptans as more effective than non-opioid analgesics, naproxen as more effective than ibuprofen, and acute medication efficacy decreased with increasing headache frequency. Trial registration: The German Migraine and Headache Society Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081).

Migraine is associated with a high individual level of suffering. Therefore, an effective preventive treatment is highly important. The spectrum of classical prophylactic drugs has now been expanded to include monoclonal antibodies against calcitonin gene-related peptide (CGRP) and its receptor. These antibodies have shown reliable efficacy compared to placebo and a rapid onset of action with a low rate of side effects and negligible interactions in pivotal studies. Recently, the efficacy of the antibody was shown in many studies even on drug-refractory migraine and migraine associated with medication overuse. Comprehensive head to head comparisons with previously established drugs and among the antibodies are not yet available; however, initial studies suggest better tolerability and efficacy compared to conventional drugs and other antibodies. The role of antibodies in established treatment cascades still needs to be clarified.Die Migräne geht mit einem starken individuellen Leidensdruck einher, weshalb einer effektiven prophylaktischen Behandlung hohe Bedeutung zukommt. Das Spektrum klassischer Prophylaktika wird nun durch monoklonale Antikörper gegen das „calcitonin gene-related peptide“ (CGRP) und dessen Rezeptor erweitert. Die Antikörper wiesen in den Zulassungsstudien eine zuverlässige Wirksamkeit gegenüber Placebo und einen raschen Wirkeintritt bei niedriger Nebenwirkungsrate und vernachlässigbaren Interaktionen auf. Zudem wurde in zahlreichen Studien unter anderem eine Wirkung der Antikörper auch bei therapierefraktärer Migräne nachgewiesen. Umfassende direkte Vergleiche der Antikörper untereinander und mit den bisher etablierten Medikamenten gibt es noch nicht. Erste Studien legen aber eine bessere Verträglichkeit und Wirksamkeit gegenüber etablierten Medikamenten oder anderen Antikörpern nahe. Die Rolle der Antikörper in den etablierten Therapiekaskaden bleibt zu klären.

Migraine is a frequently underdiagnosed disease that is associated with a high burden on affected patients. There are a variety of prophylactic treatment options available, that have been expanded with the introduction of the CGRP-(receptor-)antibodies.Status of pharmacologic and nonpharmacologic preventive treatment in migraine therapy.Analysis and evaluation of internationally published articles concerning preventive treatment of episodic and chronic migraine.There are many approved medications for migraine prophylaxis with different evidence. The possibilities were further expanded with CGRP antibodies. Comparative studies of the new antibodies with previous prophylactic drugs have not yet been published, so it's unclear whether the antibodies are therapeutically superior. What should be emphasized is their rapid onset of action and their good tolerance. Basically, an individual choice of prophylaxis, which is based on affectedness, comorbidities and comedication, makes sense. In addition, a combination with nondrug measures is always mandatory.A variety of medicinal and non-medicinal measures are available for the treatment of migraine, which should be used multimodally.

Neuromodulatory approaches have enlarged the therapeutic armamentarium for the treatment of primary headaches such as migraine and cluster headache. While invasive devices are mainly used in patients with refractory and chronic conditions, non-invasive approaches are increasingly used in less severely affected patients with episodic headaches. This article critically reviews the literature focussing on recent controlled studies, provides recommendations on their use in clinical practice and strives to integrate them into present treatment regimes. As a relevant drawback, the number of controlled studies is limited with small cohorts included and marked methodological constraints, which hampers any direct comparison with pharmacological approaches.

Die trigeminoautonomen Kopfschmerzen (TAK) zeichnen sich durch starke streng einseitige Kopfschmerzen mit Betonung in der Stirn-Schlafen-Region und/oder periorbital in Verbindung mit ipsilateral dazu auftretenden kraniellen autonomen Symptomen wie Lakrimation, konjunktivaler Injektion, Rhinorrho, nasaler Kongestion und einer Agitiertheit bzw. Unruhe aus. Sie unterscheiden sich untereinander durch die unterschiedliche Zeitdauer der Attacken. Wahrend beim SUNCT-Syndrom (Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) Attacken 5 s bis 10 min andauern, betragt die ubliche Dauer bei der paroxysmalen Hemikranie 2–30 min und beim Clusterkopfschmerz 15–180 min. Die Hemicrania continua stellt eine Dauervariante der TAKs dar. Auch hinsichtlich der Therapie bestehen deutliche Unterschiede: Beim SUNCT-Syndrom steht mit Lamotrigin und bei der paroxysmalen Hemikranie mit Indometacin die prophylaktische Behandlung im Vordergrund. Beim Clusterkopfschmerz stehen als Akutmedikation Sauerstoff (100 %, inhaliert uber Maske) sowie Sumatriptan s.c. und intranasales Zolmitriptan zur Verfugung, als Prophylaxe werden Methysergid und Cortison fur kurzere Zeitraume bzw. uberbruckend sowie Verapamil fur langere Einnahmedauern als Mittel der 1. Wahl empfohlen, Lithiumcarbonat und Topiramat als Mittel der 2. Wahl. Indometacin stellt auch fur die Hemicrania continua die Therapie der 1. Wahl dar. Gerade fur therapierefraktare Verlaufe des chronischen Clusterkopfschmerzes werden zunehmend neuromodulierende Verfahren wie die Stimulation des N. occipitalis oder des Ganglion sphenopalatinum eingesetzt.