Diagnosis and symptomatic treatment of migraine

Migraine is a common, complex neurophysiologic headache disorder. Most migraineurs have neither been diagnosed by physicians nor effectively treated. The clinical diagnosis of migraine is based on headache characteristics and associated symptoms, particularly nausea and vomiting. Pharmacologic symptomatic treatment is aimed at reversing, aborting, or reducing pain and the accompanying symptoms of an attack. Individualization of therapy is essential in determining whether symptomatic and/or preventive treatment for migraine attacks are needed. The presence of nausea and vomiting must be considered in developing a treatment plan. The patient's priorities and preferences regarding therapy must be taken into account. The goals of symptomatic treatment are to relieve pain and the associated symptoms and to optimize the patient's ability to function normally. Multiple treatment strategies utilizing combinations of 5-hydroxytryptamine1 (5-HT1) agonists (ergotamine tartrate [ET], sumatriptan, and dihydroergotamine [DHE]) with simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and opiates provide effective treatment for most attacks of moderate to severe migraine. Treatment strategies are based on the frequency, nature, and severity of attacks. Patients with intractable, acute migraine may require hospitalization and aggressive parenteral treatment. Wider use of currently available diagnostic criteria and symptomatic medications should improve the diagnosis and treatment of migraine.