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

Migraine significantly affects many people, causing major disruption to their lives. This guideline aims to provide evidence-based recommendations for treating various migraine syndromes. A thorough literature search was conducted, evaluating clinical studies on migraines with and without aura. The expert panel reviewed findings, producing level A, B, or C recommendations. For acute migraine attacks, oral NSAIDs and triptans are strongly recommended. Prior to these medications, oral metoclopramide or domperidone is suggested. For severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are preferred first-line options. Status migrainosus treatment includes corticosteroids and dihydroergotamine, though effectiveness varies. For migraine prevention, first-choice drugs include beta-blockers like propranolol and metoprolol, flunarizine, valproic acid, and topiramate. Second-choice options for prophylaxis are amitriptyline, naproxen, petasites, and bisoprolol, providing various treatment pathways for patients. Clinical relevance: This research highlights effective migraine treatments, guiding clinicians in managing patient care effectively.