[Therapy for migraine-the current state of the art and perspectives.]

Migraine is a syndrome and not a nosological entity. It is therefore relatively improbable that a uniform etiology can be defined, and it must be assumed that there are different multifactorial etiological conditions for each individual. It is probable that a therapy concept that is equally valid and promising for all patients can therefore never be developed. On the one hand, there is a variable palette of therapeutic possibilities with a fixed differential indication with regard to the different variants of migraine, and on the other subtle analysis of individual cases is necessary by means of recording the individually relevant somatic, psychological, familial and social parameters. A treatment strategy must then be developed on an individual basis, in which both elements are taken into account. Therapy studies are carried out to investigate various questions and, accordingly, may have different experimental paradigms. The intrinsic action of a therapy method should be compared to the placebo effect on a randomized doubleblind basis. If this preconditions is fulfilled, appraisals of the real chances of success in the practice can be made more accurately on the basis of large-scale open studies comprising a representative cross-section of migraine patients. Further topics for therapy studies should include the analysis of responders and nonresponders and the development of differential indications for certain methods of therapy.