Therapy of the Acute Migraine Attack. Therapy of the Migraine Attack Criteria for efficacy Pain free after 2 hrs Improvement of headache from severe.

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Therapy of the Acute Migraine Attack

Therapy of the Migraine Attack Criteria for efficacy Pain free after 2 hrs Improvement of headache from severe or moderate to mild or no pain („Glaxo criteria“) Improvement of nausea nd vomiting Improvement of photo- and phonophobia Normal functioning Consistency of response (2 out of 3 attacks)

Take Home Messages (1) The 5-HT 1B/1D -agonists Almotriptan, Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Sumatriptan and Zolmitriptan are the most effective substances for the treatment of migraine attacks Triptans are effective in the treatment of menstrually associated migraine attacks Ergot alkaloids are effective in the treatment of migraine attacks. There are only few placebo-controlled trials with low power (  ) (  )

Take Home Messages (2) Analgesics and non-steroidal antiinflammatory drugs (NSAIDs) are effective in the treatment of migraine attacks The efficacy of non-medical treatment has not been evaluated in well designed controlled trials (  ) (  )

Therapy of Migraine Attacks with 5-HT- Agonists SubstanceEvidenceDose and Applications Sumatriptan (Imigran ®, Imitrex ® )  mg p.o., 25 mg Supp mg Nasal spray 6 mg s.c. (Auto-injector) Zolmitriptan (AscoTop ® Zomig ® )  2,5-5 mg p.o. 2,5 mg Melt-tablet Naratriptan (Naramig ® )  2,5 mg p.o. Rizatriptan (Maxalt ® )  10 mg p.o. or Melt tablet Eletriptan (Relpax ® )  20, 40 oder 80 mg p.o. Almotriptan (Almogran ® )  12,5 mg p.o. Frovatriptan (Allegro ©)  2.5 mg p.o.

Sumatriptan ( Imigran ®  GlaxoSmithKline ) Zolmitriptan ( AscoTop ® AstraZeneca ) Naratriptan ( Naramig ® Glaxo/Schwarz ) Rizatriptan ( Maxalt ® MSD ) Eletriptan ( Relpax ® Pfizer ) Almotriptan ( Almogran ® Allmiral, Bayer ) Frovatriptan ( Elan, Berlin Chemie ) Avitriptan Alniditan VL 2001

Practice Recommendations for the Use of Triptans Treat at least 3 attacks Triptans are effective in patients with non- IHS migraine but not in episodic tension- type headache Triptans are not effective: add antiemetics Frequent recurrences: add NSAIDs

Treating Menstrually Related Migraine Attacks Menstrually related migraine attacks are more severe and long-lasting Triptans have proven efficacy in menstrually related migraine attacks Use triptans with long action: frovatriptan, naratriptan, eletriptan