CLINICAL PERSPECTIVES Migraine: diagnosis and management

Migraine is the most common form of disabling primary headache and affects approximately 12% of studied Caucasian populations. Non-pharmacological management of migraine largely consists of lifestyle advice to help sufferers avoid situations in which attacks will be triggered. Preventive treatments for migraine should usually be considered on the basis of attack frequency, particularly its trend to change with time, and tractability to acute care. Acute care treatments for migraine can be divided into non-specific treatments (general analgesics, such as aspirin or non-steroidal antiinflammatory drugs) and treatments relatively specific to migraine (ergotamine and the triptans). The triptans – sumatriptan, naratriptan, rizatriptan, zolmitriptan, almotriptan, eletriptan and frovatriptan – are potent serotonin, 5-HT1B/1D, receptor agonists which represent a major advance in the treatment of acute migraine. Chronic daily headache in association with analgesic overuse is probably the major avoidable cause of headache disability in the developed world. (Intern Med J 2003; 33: 436–442)