BACKGROUND:Frequent or severe migraine attacks are an indication for drug and nondrug prophylaxis. METHODS:In this narrative review, we summarize the guideline of the International Headache Society concerning the treatment and prophylaxis of migraine with drugs, with additional consideration of meta-analyses on monoclonal antibodies and gepants. RESULTS:In episodic migraine with an average of 8 migraine or headache days/month at baseline, oral prophylactic drugs lowered the number of migraine days per month by 1.27 (beta-blockers), 0.44 (flunarizine), 1.2 (amitriptyline), and 1.4 (topiramate) compared to placebo. Monoclonal antibodies against calcitonin gene-related peptide (CGRP) or the CGRP receptor are effective against both episodic and chronic migraine: Eptinezumab lowered the number of migraine days per month by 0.7-3.2, fremanezumab by 1.3-3.8, galcanezumab by 1.1-3.7, and erenumab by 1.0-2.5. High-level evidence also supports the efficacy of the CGRP receptor antagonist atogepant (0.7-2.4 fewer migraine days per month) in both episodic and chronic migraine. The monoclonal antibodies, atogepant, and onabotulinum toxin A are well-tolerated and have been found effective even in patients for whom previous oral migraine prophylactic drugs were ineffective, as well as in chronic migraine both with and without acute drug overuse. CONCLUSION:The new prophylactic drugs against migraine are effective, well-tolerated, and especially useful for patients for whom traditional oral migraine prophylactic drugs and onabotulinum toxin A are ineffective, not tolerated, or contraindicated.

Chronische Rückenschmerzen gehören zu den häufigsten Erkrankungen in Deutschland. Vielfach findet sich keine morphologisch fassbare Veränderung, sodass die Genese bei über 90% der Patienten unspezifisch bleibt. Der vorliegende Artikel soll eine Übersicht über die medikamentöse Therapie wie auch die nicht-medikamentösen Maßnahmen geben und fasst die entsprechenden Leitlinienempfehlungen zusammen.

Cabergoline, a dopamine receptor agonist, has shown beneficial effects as a preventive treatment for migraine, with no serious adverse events reported. This study aims to evaluate whether cabergoline is superior to placebo in reducing monthly migraine days (MMD), while assessing safety and tolerability. In a randomized, parallel-group, placebo-controlled, double-blind superiority phase II trial, 150 adults with 4–14 MMD will be included. Participants are randomized (1:1:1) to cabergoline 0.5 mg, cabergoline 1.0 mg or placebo once weekly as add-on treatment for 12 weeks. In a 12-week open-label extension, all participants, including those initially assigned to placebo, will be re-randomized (1:1) to cabergoline 0.5 mg or 1.0 mg once weekly to assess sustained effects and safety. The primary outcome is change in MMD from baseline to the final four weeks of the double-blind phase. Key secondary outcomes include ≥50% responder rate, change in the number of moderate-to-severe headache days, acute medication use and patient-reported outcomes (PGIC, HIT-6, MIDAS, WPAI). Exploratory analyses include biomarkers, pharmacogenetics and cost-effectiveness. Analyses will follow the intention-to-treat principle.