Neurológia pre prax 2/2022

The significance of correct algorithm of the diagnostics and treatment of migraine in the prophylactic treatment against calcitonin gene-related peptide

The paper describes the algorithm of the diagnostics and treatment of migraine which in indicated cases will lead to the initiation of modern prophylactic treatment directed against calcitonin gene-related peptide (anti-CGRP therapy). At first it is necessary to perform the correct differential diagnosis of migraine attacks from other acute primary or secondary headaches. In the next part the algorithm of the treatment of migraine is described. In few frequent uncomplicated migraine attacks the care of general practitioner is sufficient who should except prescription of acute antimigraine drugs actively follow the frequency of attacks and consumption of acute antimigraine drugs. In case of an increase in frequency of attacks and consumption of antimigraine drugs he or she should ask for help the neurologist who starts the treatment with classical prophylactics of migraine. In case of ineffectiveness and/or intolerance according to the valid criteria the patient is indicated to the headache center. Here the treatment with monoclonal antibodies against CGRP or its receptor is taken into consideration which is shortly described. The necessity of perfect medical documentation is emphasized during transfer of the patient to the center. At the end of the paper we deal with the problems of the switch in case of ineffectiveness of a monoclonal anti CGRP antibody or its receptor.

Keywords: migraine, algorithm of the treatment, monoclonal antibodies against CGRP or its receptor, medical documentation, switch