Migraine is a widespread disease that affects many people. Every year, 10 to 15 percent of the population suffer from migraines. It occurs most often between the ages of 20 and 50. In this age range, women are affected up to three times more often than men.
The disease significantly affects the quality of life. Migraines and other headaches are among the ten most common causes of working misery in Germany [1]. Therefore, adequate therapy and effective prophylaxis of migraine attacks are particularly important.
New guidelines for migraine treatment
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The latest therapy recommendations can be found in the updated guideline [2]. This was published on today’s headache day 2025. At the same time, the “Migraine” patient guideline of the German Brain Foundation appears.
Prof. Dr. Hans-Christoph Diener from Essen emphasizes that the therapy spectrum has expanded significantly in recent years. He is a leading author of the guideline, together with PD Dr. Stefanie Förderreuther, Munich, Prof. Dr. Peter Kropp, Rostock, and Prof. Dr. Uwe Reuter, Greifswald. Almost all affected people find suitable treatment options today.
Academy therapy and prophylaxis: a holistic approach
Migraine therapy basically differentiates between two areas: acute therapy and prophylactic therapy. Acute therapy deals with acute migraine attacks, while prophylactic therapy prevents attacks. Both approaches must always be considered together, says Prof. Diener. New prophylactic therapies are very effective and reduce the number and severity of the seizures.
Options for acute treatment
In the case of acute migraine attacks, the guidelines especially recommend the triptane eletriptan, rizatriptan and sumatriptan. These are particularly effective. However, there are contraindications for triptans.
People with coronary heart disease, heart attack, stroke, other vascular diseases or uncontrollable hypertension must not take these medication. These diseases often occur in the second half of life.
Effective alternatives to triptans
However, there are good alternatives to the therapy of acute migraine attacks. “Lasmiditan, a serotonin 1f receptor agonist, can be prescribed in these situations,” explains the headache expert. It has no vasoconstrictive properties. “RimePant, an antagonist on the CGRP receptor, also shows good tolerance during the treatment of acute migraine attacks and is already the first to be opened in Germany.”
Long -term migraine prophylaxis
Numerous active ingredients are suitable for the effective prevention of migraine attacks. This includes beta blockers, flunar medicine, amitriptylin, topiramate, onabotulinum toxin A (chronic migraines), panton and monoclonal antibodies against CGRP or the CGRP receptor.
Innovative prophylaxis: antibodies and panties
The monoclonal antibodies in particular are highly effective when prophylaxis of the episodic and chronic migraines. They also have a good compatibility profile. The oral browns have recently expanded the therapy spectrum.
“However, according to the current level of knowledge, both substance groups should not be used in people with an increased risk of vascular diseases,” explains Prof. Diener. “If you are affected, you do not have to do without effective drug prophylaxis and can switch to topiramate or onabotulinum toxin A.”
Non-drug therapy options
The guideline also recommends non-drug therapy options. These are suitable for both acute treatment and prophylaxis. This includes remote electrical neuromodulation (ren) and the external transcutaneous stimulation of the trigeminal nerve. So far, however, the health insurance companies have not covered the costs, and these are not insignificant.
The role of sport and lifestyle
“Endurance sport offers an effective and inexpensive possibility of sequence prophylaxis,” emphasizes Prof. Dr. Peter Berlit, Secretary General of the DGN. I also help strength sport, relaxation exercises, a regulated sleeping and meal routine as well as coping with stress to avoid migraine attacks.
Unfortunately, many affected people often do not implement these recommendations. “Many affected people want non-drug therapy, but do not find the time to practice basic measures such as relaxation techniques and endurance sports regularly,” says Prof. Berlit. Taking a drug seems more convenient, especially if it is well tolerated.
However, it is overlooked that the combination of non-drug and drug procedures achieves a better therapy effect. Sports activity should therefore be a “must” for all migraine patients.
The German Society for Neurology EV (DGN)
The German Society for Neurology EV (DGN) is a medical-scientific specialist society. With her 13,000 members, she sees herself in social responsibility. It ensures and improves neurological health care in Germany. For this purpose, DGN promotes science and research as well as teaching, further and further education in neurology. She also participates in the health policy discussion. The DGN was founded in Dresden in 1907. Your office is located in Berlin. Further information at: www.dgn.org.
More information
[1] AOK absenteeism report 2024.
[2] Diener H.-C., Förderreuther S, Kropp P., Reuter U. et al., Therapy of Migraine attack and prophylaxis of the migraines, S1 guideline, 2025, DGN and DMKG, in: German Society for Neurology (ed.), Guidelines for Diagnostics and Therapy in Neurology. Online: www.dgn.org/leitlinien (available from 05.09.2025)
President: Prof. Dr. Daniela Berg
Deputy President: Prof. Dr. Dr. Sven Meuth
Past President: Prof. Dr. Lars Timmermann
Generals Secretary: Prof. Dr. Peter Berlit
Managing Director: David Friedrich-Schmidt
Office: Budapester Str. 7/9, 10787 Berlin, Tel.: +49 (0) 30 531437930, email: info@dgn.org
5. September 2025
