EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force

Evers, S.; Áfra, J.; Frese, A.; Goadsby, P. J.; Linde, M.; May, A.; Sándor, P. S.

doi:10.1111/j.1468-1331.2009.02748.x

Cited by 892Migraine and Headache StudiesIntracranial Aneurysms: Treatment and ComplicationsCardiovascular and Diving-Related Complications

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EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force

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Evers, S., Áfra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., Sándor, P. S.·2009·European Journal of Neurology

DOI 10.1111/j.1468-1331.2009.02748.x

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Abstract

Background: Migraine is one of the most frequent disabling neurological conditions with a major impact on the patients’ quality of life. Objectives: To give evidence‐based or expert recommendations for the different drug treatment procedures in the particular migraine syndromes based on a literature search and the consensus of an expert panel. Methods: All available medical reference systems were screened for the range of clinical studies on migraine with and without aura and on migraine‐like syndromes. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies (EFNS) resulting in level A, B, or C recommendations and good practice points. Recommendations: For the acute treatment of migraine attacks, oral non‐steroidal antiinflammatory drug (NSAID) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAID and triptans, oral metoclopramide or domperidone is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. Status migrainosus can be treated by cortoicosteroids, although this is not universally held to be helpful, or dihydroergotamine. For the prophylaxis of migraine, betablockers (propranolol and metoprolol) flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis include amitriptyline, naproxen, petasites, and bisoprolol.

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Antidepressants are widely prescribed for other clinically accepted off-label uses including migraine, back pain, and insomnia.
“Furthermore, antidepressants are widely prescribed for the other clinical accepted off-label uses include migraine [46], back pain [47], insomnia [48], etc.”
From Risk analysis of use of different classes of antidepressants on subsequent dementia: A nationwide cohort study in Taiwan (2017) · cites this paper as [46]

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Lipton, R. B., Stewart, W. F., Ryan, R. E., Saper, J., Silberstein, S., & Sheftell, F. (1998) · Archives of Neurology · doi:10.1001/archneur.55.2.210 · Cited by 223

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Authors: Evers, S., Áfra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., & Sándor, P. S.
Affiliations: University of Münster (DE)
University of California, San Francisco (US)
Universität Hamburg (DE)
University of Zurich (CH)
Corresponding author: Evers, S.
ORCID: Evers, S.
Áfra, J.
Goadsby, P. J.
Linde, M.
May, A.
Sándor, P. S.
Venue: European Journal of Neurology
Publisher: Wiley
Published: 2009-08-07
Volume: 16
Issue: 9
Pages: 968-981
ISSN: 1351-5101 (ISSN-L)
1468-1331
DOI: 10.1111/j.1468-1331.2009.02748.x
OpenAlex: W2125350651
Cited by: 892
References: 2
Citations by year: 2026: 14 · 2025: 34 · 2024: 58 · 2023: 37 · 2022: 35 · 2021: 69 · 2020: 51 · 2019: 56 · 2018: 54 · 2017: 44 · 2016: 56 · 2015: 47 · 2014: 55 · 2013: 50 · 2012: 68
FWCI: 39.32
Type: journal article
Language: en
Open access: green
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: European Journal of Neurology (publishedVersion)
PubMed (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Zurich Open Repository and Archive (University of Zurich)
Topics: Health Sciences › Medicine › Clinical Neurology › Migraine and Headache Studies
Health Sciences › Medicine › Clinical Neurology › Intracranial Aneurysms: Treatment and Complications
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
Keywords: migraine, acute migraine treatment, migraine prophylaxis, triptans, nonsteroidal anti-inflammatory drugs, metoclopramide, domperidone, aspirin, sumatriptan, status migrainosus, corticosteroids, dihydroergotamine, beta-blockers, propranolol, metoprolol, flunarizine, valproic acid, topiramate, amitriptyline, naproxen, Petasites, bisoprolol, migraine with aura, migraine without aura
MeSH terms: Adrenergic beta-Antagonists, Analgesics, Anticonvulsants, Antiemetics, Calcium Channel Blockers, Humans, Migraine Disorders, Serotonin Receptor Agonists

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EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force

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