New migraine guideline calls for improved care for those affected

Migraine patients need to be better informed

The German Society of Neurology (DGN) and the German Migraine and Headache Society (DMKG) presented a new guideline for the treatment of migraine on April 26, 2018. A new key aspect is preventive measures such as medicines, sports and relaxation procedures, which have proven to be successful, but which are still under-informed.

According to the DGN, migraine sufferers at the doctor's office often are not adequately advised on preventive measures against migraine attacks. The new guideline explains with which preventive measures seizures are demonstrably rarer and milder. The new guideline is freely accessible on the DGN website.

According to the new migraine guideline, too few patients benefit from preventive measures against headache disease. (Image: eggeeggjiew / fotolia.com)

Migraine sufferers are not sufficiently cared for in Germany

"The treatment options are currently not exhausted in all patients," says Professor Hans-Christoph Diener, headache expert of the DGN in a press release on the publication of the guideline. With the guideline, the DGN wants to improve the care situation for children and adults with migraine. Here physicians and patients will find a comprehensive overview of the current state of knowledge.

What helps with migraines and what not?

The guideline covers nearly 100 pages and is intended as a reference book for acute and preventive measures against migraine. It provides comprehensive information on how effective the respective drug, non-drug and interventional procedures are. Positions are also taken on special situations such as migraine in pregnancy.

About migraine

According to DGN, migraine is the most common neurological disease in Germany. About eight to ten percent of men and ten to 25 percent of women are affected. According to a Global Burden of Disease Survey, a migraine disease can severely affect a person's life. In terms of incidence, this headache disorder occupies the top spot in all neurological diseases in people between the ages of 15 and 49 years.

Prophylaxis opportunities are hardly exhausted

The DGN reports on a recent representative survey of the DMKG, which shows that the prophylactic options are hardly exhausted. Less than half (43%) of migraineurs would consult with family doctors or internists for preventive measures. Even among medical specialists, only 57 percent of those seeking help would receive appropriate information.

Only one in five receives prophylaxis

"Only 22 percent of migraine sufferers who could benefit from prophylaxis also receive preventive medication or measures," explains Dr. Charly Gaul, Secretary General and Press Officer of the DMKG, who participated in the guideline. The fact that even medicamentous measures can not be used in the treatment of migraine, many patients are not aware.

For family doctors, specialists, pain therapists and those affected

"The new migraine guideline is a further development of six German and international guidelines and is currently the most up-to-date guide to migraine treatment," concludes Professor Diener. The recommendations are just as relevant for primary care physicians and internists as they are for neurologists, neurologists and pain therapists. Non-physicians and migraine sufferers can also access the guideline freely.

New drug recommendations for migraine

The guideline contains recommendations for all medications that are currently considered to be suitable for acute therapy and prophylaxis. A new recommendation is the use of the drugs topiramate and onabotulinum toxin A in chronic migraine. Also new is that in the case of migraine prophylaxis in children given a very high placebo rate no therapeutic superiority of valproic acid, topiramate or amitriptyline could be shown. For the acute treatment of migraine attacks, triptans are still the most effective.

Medicines for migraine prophylaxis

"The effectiveness of the beta-blockers metoprolol and propranolol, the calcium antagonist flunarizine, the anticonvulsant topiramate and valproic acid and the tricyclic antidepressant amitriptyline are best documented in migraine prophylaxis by randomized studies," writes the DGN. In addition to the drug treatment, non-drug therapies receive more attention.

Higher priority of non-drug procedures

"Regular endurance sports help prevent migraine attacks," adds Professor Peter Kropp, director of the Institute of Medical Psychology and Medical Sociology at the University of Rostock. Relaxation methods and measures for stress relief would have proven to be effective in prophylaxis. The non-drug-based behavioral therapy methods are so effective that they can be used as an alternative to drug prophylaxis, Kropp said.

In addition to the recommendations of the DNG, some migraineurs swear by well-tried home remedies for migraine. (Vb)