Therapy of migraine

Migraine is one of the most common forms of primary headache with a lifetime prevalence for women of over 25 %. Migraine is characterized by episodes of severe, commonly unilateral, pulsating headache and is mostly accompanied by nausea, vomiting, photophobia, phono- and osmophobia. First line therapy for the acute migraine attack are analgesics like paracetamol and acetylsalicylic acid or specific drugs like triptans. To prevent the development of medication over-use headache prophylactic treatment should be considered for patients with more than three migraine attacks per month or high risk for the development of chronic daily headache. First line substances for migraine prophylaxis are betablockers, flunarizine and topiramate. Additional behavioural measures should be recommended as support for medical treatment such as aerobic exercise, relaxation techniques, and stress management.