Migraine, Affective Disorder Andanxiety Disorder

classification system for headache by the International Headache Society should be considered relevant to the practice of psychiatrists and other mental health specialists (Headache Classification Subcommittee of the International Headache Society, 2004). Migraine is a chronic paroxysmal disorder characterised by stereotypical attacks of headache, focal neurological symptoms or a combination of both. The most commonly diagnosed migraine subtypes are migraine without aura and migraine with aura (to be known henceforth as ‘typical aura with migraine headache’), which have a joint population prevalence in Europe and North America of approximately 10–12%. The updated diagnostic criteria for these and other headache disorders have been published in Cephalalgia (2004), 24 (suppl. 1) (online at http://216.25.100.131/ ihscommon/guidelines/pdfs/ihc_II_main_no_ print.pdf). Migraine imposes a substantial burden, not only on individual headache sufferers, but also on society at large. The World Health Organization recently classified migraine as the 19th leading cause of disability worldwide (World Health Organization, 2001: Fig. 2.3). In addition, primary care pharmaceutical expenditure in the UK is estimated at £69.6 million per annum (R. Harkins, personal communication, 2004), and migraine is conservatively estimated to cost the UK economy in excess of £750 million per annum in terms of lost productivity (Cull et al, 1992).