The doctor and the migraine patient: improving compliance

Migraine is an underdiagnosed and undertreated disorder. This can be attributed to the low consultation rate for migraine, for which many reasons have been proposed. These include the fact that many migraineurs self-treat and, historically, the lack of available effective treatments. Some migraineurs are referred to specialist centers for advice. These patients do not merely need effective pain relief. They also need an explanation of the cause of the migraine and reassurance that their headache pain does not have a more sinister cause. By spending time with patients and taking a full history of their migraine condition, the physician can propose a management strategy that is appropriate to each individual patient, thus providing a tailored-care approach. Thorough exploration of possible trigger factors for migraine and advice on avoidance may help to reduce attack frequency. Simple techniques can also be used to improve compliance with prescribed therapies. For example, it is important for the physician to establish that the patient understands any instructions given and to reinforce this advice at follow-up visits. Regular follow-up is important because it enables management strategies to be evaluated and helps the patients to feel involved in the management of their migraine. A correct understanding of the way a drug works and the nature of the condition, together with an explanation of any potential side effects, is likely to maximize clinical benefit.