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Alternativen zu Betablockern in der Migräneprophylaxe

Alternatives to beta blockers in preventive migraine treatment

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Zusammenfassung

Eine medikamentöse Prophylaxe der Migräne wird empfohlen, wenn mehr als drei Attacken pro Monat auftreten, die Akuttherapie nicht hinreichend wirksam ist oder besondere schwere Attacken mit Aura im Vordergrund stehen. Neben Betablockern hat inzwischen eine Vielzahl von Substanzen eine Evidenz in der Migräneprophylaxe, so dass eine differenzierte Therapie möglich ist. Die Auswahl der Substanz erfolgt dabei eher nach den potenziellen Nebenwirkungen als nach der Effektivität. Mittel der 1. Wahl sind neben Betablockern Flunarizin, Valproinsäure und Topiramat. Mittel der 2. Wahl mit weniger Effektivität oder schlechterer Evidenz sind Amitriptylin, Venlafaxin, Gabapentin, Naproxen, Acetylsalicylsäure, Pestwurz, Vitamin B2 und Magnesium. Bei Kindern werden Flunarizin oder Propranolol empfohlen.

Summary

Drug prevention of migraine is recommended if more than three attacks occur per month, acute drug treatment is insufficient, or very severe attacks with aura are the main problem. Besides beta blockers, a variety of substances have proved efficacious in migraine prevention. Thus individualised treatment of migraine patients is possible. When choosing the appropriate preventive drug, the potential side effects are considered. Drugs of first choice, besides beta blockers, are flunarizine, valproic acid, and topiramate. Second-choice drugs with lower efficacy or less well published evidence include amitriptyline, venlafaxine, gabapentin, naproxen, acetylsalicylic acid, butterbur root, vitamin B2, and magnesium. Flunarizine or propranolol are recommended for children.

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Der korrespondierende Autor weist auf folgende Beziehung/en hin: Honorare für folgende Firmen: Janssen-Cilag, Weber + Weber, Allergan.

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Evers, S. Alternativen zu Betablockern in der Migräneprophylaxe. Nervenarzt 79, 1135–1143 (2008). https://doi.org/10.1007/s00115-008-2522-2

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