Table 1.
Substances used for migraine treatment recommended by EFNS Guideline on the treatment of migraine16
| LR | Substance | Dose (if not given in mg) | Side effects | Contraindications |
|---|---|---|---|---|
| Acute migraine treatment | ||||
| A | ASA | 1000 (oral) 1000 (iv) | gastrointestinal side effects, abdominal pain, clotting abnormality, risk of bleeding | gastric ulcer, bleeding diathesis, pregnancy (months 7–9) |
| A | Ibuprofen | 200–800 | side effects as for ASA, edema | like ASA (less bleeding tendency), renal failure, pulmonary embolism |
| A | Naproxen | 500–1000 | like ibuprofen | like ibuprofen |
| A | Acetaminophen/paracetamol | 1000 (oral or suppository) | liver damage | liver and kidney failure |
| A | Diclofenac | 50–100 | like ibuprofen | like ibuprofen |
| A | ASA plus paracetamol plus caffeine |
250 (oral) 200–250 50 |
see ASA and paracetamol | see ASA and paracetamol |
| B | Metamizol | 1000 (oral) 1000 (iv) | allergic reaction, changes in blood count, risk of agranulocytosis in iv use risk of hypotension | hematopoietic system disease |
| B | Phenazon | 1000 (oral) | see paracetamol | unknown |
| B | Tolfenamic acid | 200 (oral) | side effects as for ASA | unknown |
| A | Sumatriptan | 25, 50, 100 (oral) 25 (suppository) 10, 20 (nasal spray) 6 (subcutaneous) |
angina, nausea, distal paresthesia, fatigue sensation of cold in subcutaneous use – local skin reaction at injection site | arterial hypertension (untreated), coronary heart disease, peripheral artery occlusive disease, cerebrovascular disease, multiple vascular risk factors, Raynaud’s disease, pregnancy, lactation, age under 18 (except sumatriptan nasal spray), severe liver or kidney failure, age above 65, simultaneous treatment with ergotamine, within 2 weeks after break off from treatment with a MAO inhibitor |
| A | Zolmitriptan | 2.5, 5 (oral) 2.5, 5 (nasal spray) |
see sumatriptan | see sumatriptan |
| A | Naratriptan | 2.5 (oral) | see sumatriptan (probably milder/fewer side effects) | see sumatriptan |
| A | Rizatriptan | 10 (oral) 5 mg (when additionally on propranolol) |
see sumatriptan | see sumatriptan |
| A | Almotriptan | 12.5 (oral) | see sumatriptan (probably milder/fewer side effects) | see sumatriptan |
| A | Eletriptan | 20, 40 (oral) 80 allowed if 40 not effective |
see sumatriptan | see sumatriptan |
| A | Frovatriptan | 2.5 (oral) | see sumatriptan (probably milder/fewer side effects) | see sumatriptan |
| Prophylactic migraine treatment | ||||
| A | Metoprolol | 50–200 | oft: fatigue, arterial hypotension occ.: sleep disturbances, dizziness |
a: AV block, bradycardia, asthma and sick sinus syndrome |
| A | Propranolol | 40–240 | s: hypoglycemia, bronchospasm, bradycardia, gastrointestinal side effects, impotence | r: diabetes mellitus, depression, diabetes mellitus, orthostatic disregulation |
| A | Flunarizine | 5–10 | oft: fatigue, weight gain occ: gastrointestinal side effects, depression s: hyperkinesia, tremor, parkinsonism |
a: focal dystonia and depression, pregnancy and lactation r: familiar parkinsonism |
| A | Valproic acid | 500–1800 | oft: fatigue dizziness, tremor occ: exanthema, hair loss, weight gain s: elevation of liver enzymes/disturbance in liver function |
a: liver failure, pregnancy, alcoholism, polycystic ovaries |
| A | Topiramate | 25–100 | oft: fatigue, cognitive disturbance, weight loss, paresthesia occ: change in taste, psychosis s: glaucoma |
a: renal insufficiency, nephrolithiasis, glaucoma |
| B | Amitriptyline | 50–150 | oft: dry mouth, fatigue, dizziness, sweating occ: constipation, impotence, incontinence, restlessness |
a: glaucoma, prostatic adenoma and hyperplasia r: heart insufficiency |
| B | Venlafaxine | 2 × 75–150 | oft: fatigue, loss of concentration s: impotence, arterial hypertension |
a: severe hypotension |
| B | Naproxen | 2 × 250–500 | gastrointestinal side effects | a: gastric ulcer, bleedings r: asthma bronchiale |
| B | Petasites | 2 × 75 | occ: burping, gastrointestinal side effects s: liver disturbances |
a: pregnancy and lactation |
| B | Bisoprolol | 5–10 | see metoprolol and propranolol | |
| C | Gabapentin (1200–1600 mg), Magnesium (24 mmol), Tanacetum parthenium (3 × 6.25 mg), Riboflavin (400 mg), Coenzyme Q10 (300 mg), Candesartan (16 mg), Lisinopril (20 mg), Methysergide (4–12 mg) | |||
Notes: Evidence class A indicates the presence of multiple randomized controlled clinical trial; evidence class B indicates one randomized trial exists or multiple uncontrolled trials were performed; evidence class C refers to common expert opinion or single case reports.
Abbreviations: ASA, acetylsalicylic acid; AV, atrioventricular; oft, often; occ, occasionally; s, seldom; a, absolute; r, relative; LR, level of recommendation; MOA, monoamine oxidase inhibitor.