Migraine: diagnosis and rational treatment

When patients present with severe, incapacitating headaches, they are often concerned with whether or not they are suffering from a severe illness, or even a brain tumor. The next concern is the relief of the incapacitating pain. In adults, primary headache disorders account for approximately 80% of the headaches experienced, compared with 20% for secondary headache disorders. Migraine, one of the most common disabling headaches, afflicts more than 18 million women and 5 million men with severe, incapacitating pain. Determining which headache patient requires a detailed evaluation can be facilitated by the use of the International Headache Society criteria, a thorough history, and a complete physical examination. The management of headaches, specifically migraines, encompasses both pharmacologic and nonpharmacologic strategies, requiring the integration of new medications into our established treatment profiles. Selecting appropriate pharmacologic therapy also requires the recognition of comorbid conditions associated with headache. Physicians and allied health care professionals can improve the quality of life and headache patients by instituting and coordinating comprehensive therapeutic approaches.