S1-Leitlinie: Therapie der Migräneattacke und Prophylaxe der Migräne

Diener, H.C.; Förderreuther, S.; Kropp, Peter

doi:10.1007/s42451-023-00550-2

Cited by 18 publications

(13 citation statements)

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“…For triptans and non-opioid analgesics, dosages and percentages of subjects using low doses (with respect to those recommended in the German guideline [4]) are listed in Table 3. Use of low doses was frequent for metamizole, paracetamol and acetylsalicylic acid (ASA).…”

Section: Resultsmentioning

confidence: 99%

“…Finding and appropriately using an effective acute medication is one of the mainstays of migraine therapy. Clinical trials have demonstrated efficacy of various non-opioid analgesics, triptans, combination analgesics and, most recently, of ditans and gepants for treatment of the acute migraine attack (1)(2)(3)(4). Real-world data focusing on the patients' perspective such as data from headache registries are essential to complete the picture.…”

Section: Introductionmentioning

confidence: 99%

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What do patients’ efficacy and tolerability ratings of acute migraine medication tell us? Cross-sectional data from the DMKG Headache Registry

et al. 2023

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Background Most migraine patients need an effective acute medication. Real-world data can provide important information on the performance of acute migraine medication in clinical practice. Methods We used data from the German Migraine and Headache Society Headache Registry, where patients rate efficacy and tolerability of and satisfaction with each of their acute headache medications. Results A total of 1756 adult migraine patients (females: 85%, age: 39.5 ± 12.8 years, headache days per month: 13.5 ± 8.1) were included. Of these, 93% used acute medication, most frequently triptans (59.3%) and/or non-opioid analgesics (56.4%), and 58.5% rated efficacy as good or very good. This was more frequent for triptans (75.4%) than for non-opioid analgesics (43.6%, p < 0.001). Among non-opioid analgesics, naproxen was rated most effective (61.9% very good or good, p < 0.001 compared to ibuprofen, acetylsalicylic acid and paracetamol). Patient-rated efficacy significantly declined with higher headache frequencies (p < 0.001), and this effect remained significant after omitting patients overusing acute medication. Conclusion In the present population recruited at specialized headache centers, patients rated triptans as more effective than non-opioid analgesics, naproxen as more effective than ibuprofen, and acute medication efficacy decreased with increasing headache frequency. Trial registration: The German Migraine and Headache Society Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081).

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What do patients’ efficacy and tolerability ratings of acute migraine medication tell us? Cross-sectional data from the DMKG Headache Registry

et al. 2023

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“…Bei leichten oder mittelschweren Migränekopfschmerzen kommen Analgetika wie Acetylsalicylsäure (ASS), Ibuprofen, Diclofenac-Kalium oder Naproxen zum Einsatz (▶ Tab. 1) [1]. Metamizol ist ebenfalls wirksam, hat allerdings in sehr seltenen Fällen schwerwiegende unerwünschte Arzneimittelwirkungen.…”

Section: Medikamentöse Therapie Der Akuten Migräneattackeunclassified

Medikamentöse Therapie der akuten Migräneattacke und Prophylaxe der Migräne

Diener¹,

Gaul²

2023

Dtsch Med Wochenschr

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Die Migräne hat in Deutschland eine Prävalenz von 10 % und ist damit die häufigste neurologische Erkrankung. Die Therapie der Migräne umfasst die Behandlung der akuten Migräneattacke und, wenn notwendig, die Prophylaxe der Migräne. Die Behandlung der akuten Migräneattacke erfolgt üblicherweise durch Medikamente. Bei der Prophylaxe werden Medikamente, Nahrungsergänzungsmittel und nicht medikamentöse Verfahren unterschieden. In dieser Übersicht werden zunächst die medikamentösen Therapieoptionen dargestellt.

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“…In real-world settings, these non-responders have often already failed numerous previous preventive treatment attempts, since this is a prerequisite for reimbursement of CGRP mAbs in many countries ( 12 – 14 ). At the time of the present study, German reimbursement regulations required failure of ≥4 (EM) and ≥5 (CM) first-line migraine preventive medications due to either insufficient efficacy, adverse effects, or contraindications before initiation of a CGRP mAb therapy ( 15 ). These first-line preventatives include beta-blockers (metoprolol or propranolol), amitriptyline, topiramate, flunarizine, and additionally OnabotulinumtoxinA for CM ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…At the time of the present study, German reimbursement regulations required failure of ≥4 (EM) and ≥5 (CM) first-line migraine preventive medications due to either insufficient efficacy, adverse effects, or contraindications before initiation of a CGRP mAb therapy ( 15 ). These first-line preventatives include beta-blockers (metoprolol or propranolol), amitriptyline, topiramate, flunarizine, and additionally OnabotulinumtoxinA for CM ( 15 ). Switching from a CGRP ligand mAb to a CGRP receptor mAb and vice versa is a possibility in the absence of alternatives.…”

Section: Introductionmentioning

confidence: 99%

Effect of switching to erenumab in non-responders to a CGRP ligand antibody treatment in migraine: A real-world cohort study

et al. 2023

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BackgroundTherapeutic options for migraine prevention in non-responders to monoclonal antibodies (mAbs) targeting Calcitonin Gene-Related Peptide (CGRP) and its receptor are often limited. Real-world data have shown that non-responders to the CGRP-receptor mAb erenumab may benefit from switching to a CGRP ligand mAb. However, it remains unclear whether, vice versa, erenumab is effective in non-responders to CGRP ligand mAbs. In this study, we aim to assess the efficacy of erenumab in patients who have previously failed a CGRP ligand mAb.MethodsThis monocentric retrospective cohort study included patients with episodic or chronic migraine in whom a non-response (< 30% reduction of monthly headache days during month 3 of treatment compared to baseline) to the CGRP ligand mAbs galcanezumab or fremanezumab led to a switch to erenumab, and who had received at least 3 administrations of erenumab. Monthly headache days were retrieved from headache diaries to assess the ≥30% responder rates and the absolute reduction of monthly headache days at 3 and 6 months of treatment with erenumab in this cohort.ResultsFrom May 2019 to July 2022, we identified 20 patients who completed 3 months of treatment with erenumab after non-response to a CGRP ligand mAb. Fourteen patients continued treatment for ≥6 months. The ≥30% responder rate was 35% at 3 months, and 45% at 6 months of treatment with erenumab, respectively. Monthly headache days were reduced from 18.6 ± 5.9 during baseline by 4.1 ± 3.1 days during month 3, and by 7.0 ± 4.8 days during month 6 compared to the month before treatment with erenumab (p < 0.001, respectively). Responders and non-responders to erenumab did not differ with respect to demographic or headache characteristics.ConclusionSwitching to erenumab in non-responders to a CGRP ligand mAb might be beneficial in a subgroup of resistant patients, with increasing responder rates after 6 months of treatment. Larger prospective studies should aim to predict which subgroup of patients benefit from a switch.

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S1-Leitlinie: Therapie der Migräneattacke und Prophylaxe der Migräne

Cited by 18 publications

References 0 publications

What do patients’ efficacy and tolerability ratings of acute migraine medication tell us? Cross-sectional data from the DMKG Headache Registry

What do patients’ efficacy and tolerability ratings of acute migraine medication tell us? Cross-sectional data from the DMKG Headache Registry

Medikamentöse Therapie der akuten Migräneattacke und Prophylaxe der Migräne

Effect of switching to erenumab in non-responders to a CGRP ligand antibody treatment in migraine: A real-world cohort study

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