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At the heart of every migraine treatment concept is the management of the acute attack with effective medication. Here, the triptans have been progressively replacing the ergot alkaloids with their unsatisfactory relationship between effect and side effects. Prophylactic medication is indicated when, despite every non-pharmaceutic measure, migraine attacks occur on seven or more days in a month. The beta receptor blockers metoprolol and propranolol have so far been considered the substances of first choice, but in practice there is now a trend towards substances with a lower potential for side effects. The article provides an up-to-date overview of the efficacy and tolerability of the various migraine prophylactics.
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