[Migraine--summary of diagnostic and therapeutic strategies]

The International Headache Society 1988 has boosted the research on and therapy of migraine by classifying the headache and operationalizing the diagnostic criteria in the recent years. The prevalence of migraine (12% in the western industrial countries) and its genetic causes are now undoubted. Numerous short-term or long-term triggers, like for instance the female hormone constellation from puberty to menopause, or prolonged stress, contribute considerably to the severity and frequency of the illness. Due to the central role of serotonin in the pathomechanism of the migraine headache and intensive research on the part of the pharmaceutical industry it was possible to develop a new, efficient drug for the treatment of migraine attacks: sumatriptan, a 5HT1-agonist. The efficiency of prophylactics has been defined and covered. For about one third of the migraine patients a long-term therapy, which is continuously adapted, is necessary, because they suffer simultaneously from a tension-type headache and a continual headache due to an abuse of pain-killers or ergotamin (analgesic or ergotamin headache), and from accompanying anxiety syndromes, depression and cervical syndromes. Only in this way can the abuse of pain-killers or ergotamin be prevented or cut back, the fear of the next attack reduced, and the ability to work maintained as well as the quality of life improved. The strategies of the therapy of migraine attacks and their prophylaxis are summed up.