Therapeutic target
Avoidance of attacks
Therapy recommendations
- Therapy of the attack is possible only by prophylaxis (prevention) because of its short duration.
- Carbamazepine (first-line agent; antiepileptic); if carbamazepine/oxcarbazepine (the latter as an alternative to carbamazepine; off-label use) is not tolerated or is not sufficiently effective, the antiepileptic agents pregabalin or gabapentin can be added.
- Therapy for advanced disease courses:
- Baclofen (from the group of muscle relaxants) as an add-on for pain attacks.
- Levetiracetam, topiramate, and valproic acid [see S1 guideline below].
- In case of nonresponse to carbamazepine and other anticonvulsant drugs: Botulinum toxin