Migraine treatment – updated recommendations 2024 –development of the Expert Group of the Headache Section ofthe Polish Neurological Society and the Polish Society for theStudy of Pain

Abstract

Migraine is one of the most frequent disabling neurological conditions with a major impact on the patients qualityof life. Migraine treatment recommendations are provided based on a review of the literature from randomizedclinical trials and the consensus of a national expert panel. All available medical reference systems were screened for the range of past and present clinical studies on migraine with and without aura and on migraine-like syndromes.The results of these studies were presented in accordance with the recommendations of the Migraine Section ofthe Polish Neurological Society and the Polish Society for the Study of Pain. For the acute treatment of migraineattacks, oral non-steroidal antiinflammatory drug (NSAID), triptans and new class of drugs gepants and ditans arerecommended. The administration should follow the concept of stratified treatment. Before intake of NSAID andtriptans, oral metoclopramide is recommended. In very severe attacks, subcutaneous sumatriptan are drugs of firstchoice. Status migrainosus can be treated by cortoicosteroids, although this is not universally held to be helpful. Forthe prophylaxis of migraine, old and new drugs – betablockers flunarizine, valproic acid, and topiramate as well asmonoclonal anti CGRP antibodies, gepants and botulin toxin are drugs of first choice.