Education And Debate

Fortnightly Review: Diagnosis and management of migraine

BMJ 1996; 312 doi: (Published 18 May 1996) Cite this as: BMJ 1996;312:1279
  1. Peter J Goadsby, reader in clinical neurologya,
  2. Jes Olesen, professor of neurologyb
  1. a Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  2. b Department of Neurology, Glostrup Hospital, Glostrup, Denmark
  1. 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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