Migraine headache: signs and symptoms, biochemistry, and current therapy

The classification, biochemistry, precipitating factors, differential diagnosis, treatment of acute attacks, and prophylactic therapy of migraine headaches are reviewed. The biochemistry of both classic (prodromal symptoms) and common (no prodromal symptoms) migraines is poorly understood, but appears to involve serotonin. Although their clinical importance is not clear, common precipitating factors include coffee, tea, and cola beverages; chocolate, cheese, and alcohol; light stimulation, stress, fasting, lack of sleep, and fever; and reduced estrogen levels. The symptomatic treatment of acute attacks with ergot preparations, isometheptene, flufenamic acid, analgesics and sedatives is reviewed. Prophylactic therapy with methysergide maleate, tricyclic compounds, monoamine oxidase inhibitors, propranolol, and 5-hydroxytryptophan is also discussed.