Fortnightly Review: Diagnosis and management of migraine

BMJ 1996;312:1279-1283 (18 May)

Education and debate

Fortnightly Review: Diagnosis and management of migraine

Peter J Goadsby, reader in clinical neurology,^a Jes Olesen, professor of neurology ^b

^a Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, ^b Department of Neurology, Glostrup Hospital, Glostrup, Denmark

Correspondence to: Dr Goadsby.

Summary points

Before a primary headache such as migraine is diagnosed, secondary headaches should be considered and eliminated on clinical grounds or by appropriate investigations
Migraine is primarily diagnosed by eliciting a history of episodic headache with characteristic associated features. The use of diagnostic headache diaries and simple calendars is strongly encouraged
Optimum treatment of migraine requires explaining the problem to the patient and identifying and avoiding precipitating factors
Treatment may be non-pharmacological or pharmacological. Drugs may be for treating acute attacks, which is required by nearly all patients, or prophylaxis, which is used by patients with frequent severe attacks
Treatment for an acute attack should result in mild or no headache by two hours after drug ingestion, while prophylactic treatment should result in a 50% reduction in the frequency of attacks
Characterisation of the 5-hydroxytryptamine receptor of the 5-HT1 class has provided better treatments for acute attack and impetus for studying mechanism of migraine

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