[Migraine--considerations on the achievements in medicine]

Migraine is among the most mysterious diseases. It has been known for centuries but as yet it has resisted the advances in medicine and has not revealed its aetiology, mechanism of headache and possibilities of treatment. Various theories on the pathogenesis of migraine and arguments for and against them are reviewed here. The most convincing hypothesis seems to be that which covers all the achievements in this field, that is the neuronal-vascular theory in which serotonin is given the role of the main biochemical factor. The diagnosis of migraine is easy if its history is known, but the first attack, especially if very severe, may be difficult to diagnose and should be differentiated from meningitis or intracranial haemorrhage. The modern imaging techniques confirm the development of transient ischaemia in the brain which can explain the aura and the post-attack manifestations. The treatment includes interruption of attack and prevention of further attacks. As long as the aetiology and pathogenesis of migraine remain not fully understood, the interruption of attacks seems to be the most adequate management and here new possibilities have been demonstrated connected with the discovery of serotonin receptors. Prophylactic treatment may be justified only in severe and frequent attacks and its effectiveness is temporary. In summary it may be stated that as yet only several unshakeable facts have been established in the aetiology and pathogenesis of migraine: heritability, serotonin, vascular system of the head, trigeminal nerve, cerebral centres of inexact location and factors provoking attacks. They all are forming a chain of relationships which remains in the realm of hypotheses.