The diagnosis and treatment of migraine: a clinician's view

The introduction of the International Headache Society (IHS) diagnostic criteria has made migraine a 'positive' diagnosis, not one of exclusion. Studies in Canada have shown that many sufferers do not consult their physician about their migraine, and that the use of over-the-counter and prescription analgesics is common. Treatment should comprise a physician-patient partnership based on a correct and accepted diagnosis, in which both participate in a programme of education about the condition, identification and reduction of migraine triggers, and appropriate use of non-pharmacological, prophylactic and acute pharmacological treatments. The pathogenesis of chronic daily headache is uncertain, but it is frequently associated with habitual overuse of simple analgesics and ergotamines.