In collaboration with some of the leading headache centres in Germany, Switzerland and Austria, we have established new guidelines for the treatment of migraine attacks and the prevention of migraine. A thorough literature research of the last 10 years has been the basis of the current recommendations. At the beginning, we present therapeutic novelties, followed by a summary of all recommendations. After an introduction, we cover topics like drug therapy and practical experience, non-effective medication, migraine prevention, interventional methods, non-medicational and psychological methods for prevention and therapies without proof of efficacy.

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Introduction Wound healing disturbances as possible side effects of calcitonin gene-related peptide (CGRP) antibody treatment have been discussed previously but not yet described in humans. Basic research suggests that calcitonin gene-related peptide plays an important role in keratinocyte migration, vascularization and immune response and lack of calcitonin gene-related peptide may lead to impaired wound healing. Case A 51-year-old female migraine patient was treated with the CGRP receptor antibody erenumab for 6 months, which led to a relevant reduction of migraine days. During the treatment, two periods of severely impaired wound healing occurred after a trivial skin injury without spatial relation to the injection site. Skin biopsy confirmed a deep perivascular and interstitial lymphohistiocytic infiltrate with admixed eosinophils, ulceration of the epithelium, a heavy edema of the papillary dermis and focally thrombosed vessels. Conclusion Impaired wound healing might be relevant side effects of CGRP antibody therapy and anamnesis within the course of treatment should also include possible observation of impaired wound healing or planned surgery.

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Functional neuroimaging was able to identify key structures for the pathophysiology of trigeminal autonomic cephalalgias (TACs) including cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing or cranial autonomic features and hemicrania continua. The posterior hypothalamus was the structure most consistently depicted with functional imaging in different states of disease with and without pain. Network-oriented imaging techniques such as resting-state functional resonance imaging were able to show a broader involvement of human trigeminal pain processing in the underlying pathophysiological mechanisms of the different TACs, highlighting similarities between this distinct group of primary headache disorders, while also demonstrating the differences in brain activation across these disorders. The most important clinical assignment for neuroimaging research from the treating physician remains the objective and reliable distinction of each individual TAC syndrome from one another, to make the correct clinical diagnosis as the foundation for proper treatment. More research will be necessary to fulfill this unmet need.

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The classification of the International Headache Society (IHS) generally differentiates episodic from chronic headache. Chronic migraine is defined as headache on 15 and more days a month over more than 3 months and headache on 8 days or more fulfils the criteria for migraine or were triptan/ergot-responsive when thought to be migrainous in early stages of the attack. The prevalence of chronic migraine is estimated at 2-4 %. The quality of life is highly compromised in this condition and comorbidities are much more frequent compared to episodic migraine. Data from prospective randomized studies are scarce as most patients with chronic migraine were excluded from previous trials and only few studies were conducted for this condition. The efficacy for prophylactic treatment compared with placebo is proven for topiramate and onabotulinum toxin A.

Zusammenfassung Kopfschmerzerkrankungen geh?ren zu den h?ufigsten neurologischen Krankheitsbildern. Zudem besteht oft eine erhebliche Einschr?nkung der Lebensqualit?t mit auch gro?er sozio?konomischer Belastung. Dieses spiegelte sich in den Versorgungsstrukturen nur eingeschr?nkt wider. Aufgrund der resultierenden Unterversorgung wurde seit Mitte der 90er Jahre das Konzept der Integrierten Versorgung f?r Kopfschmerzpatienten punktuell in Deutschland etabliert und ausgebaut. Dabei ist die Multidisziplinarit?t sowohl f?r das Patienten-Assessment als auch f?r die Therapie der zentrale Bestandteil dieser Versorgungsstruktur. Dieser Artikel gibt detaillierte Einblicke in die Zusammenarbeit von ?rzten, Psychologen und Physiotherapeuten in der Behandlung von Kopfschmerzpatienten. Dabei werden Grunds?tze und Details der Versorgung sowie Outcome-Daten der beteiligten Zentren in Essen, M?nchen, Jena, Berlin und Kiel strukturiert dargestellt. Aufbauend auf den Erfahrungen der IV sollte die zuk?nftige Versorgung sektoren?bergreifend, multidisziplin?r mit koordiniertem Behandlungsablauf organisiert werden.