Flammer syndrome is mostly harmless, and therefore, most subjects require no treatment. However, if the symptoms are annoying or affected individuals develop related diseases, we consider treatment as necessary. The intensity of the treatment depends on the clinical picture and the individual situation. Although little research has been conducted on treatment, we can still assist these patients based on the information available.

The treatment is based on three pillars: (a) lifestyle management (b) nutrition and (c) drug therapy.

Lifestyle management

Most subjects with Flammer syndrome know what triggers their vasospastic episodes; as a consequence, one can recommend ways to avoid those. These can include thermal protection, prevention of stress, regular sleep and regular, but not excessive physical activity and moderation in sports. Autogenic training or yoga can help to relax. Enough adaption time should be taken when going to high altitude, etc.Certain vasoconstrictive drugs should be avoided and some other drugs should be taken in a lower dose than the normal.

Nutrition

The symptoms inversely correlate with body mass index. We therefore recommend eating enough to avoid excessive leanness. Fasting periods trigger symptoms. If blood pressure is low, salt and fluid intake can be increased, particularly in the evening to avoid excessive nocturnal blood pressure dips. Omega-3 fatty acids, as those contained in fish, are also recommended. Since oxidative stress, induced by the unstable oxygen supply, may increase, particularly in the eye, antioxidative diet is considered.

Drug treatment

Magnesium, a physiological calcium channel blocker (CCB), reduces the vasoconstrictive effect of endothelin-1 and improves blood flow regulation. A relatively high dose of at least 10–20 mmol/day magnesium is needed. The only side effect observed is diarrhea which mitigates quickly, when the dose is reduced.
If not sufficient, then magnesium is combined with a very low dose (!) of calcium channel blockers. But it must be done only with a doctor's prescription. Many other substances are currently under investigation. Ginkgo biloba has already been proved effective.
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