Migraine--diagnosis and treatment.

BACKGROUND

Migraine is a genetically determined recurrent pain syndrome accompanied by neurological and gastrointestinal features, involving interaction of external triggers and internal pathophysiology and the cause of considerable disability to sufferers.

OBJECTIVE

This article discusses the pathophysiology and diagnosis of migraine and outlines a patient centred approach to management.

DISCUSSION

Establishing the correct diagnosis is essential for success. Discussing a structured approach ("a puff, a gust, and a gale") in the recognition of a developing migraine attack can assist patients in appropriate self management. A "stepped care" approach to management of acute migraine involves initial nonpharmacological methods followed by antiemetics and simple analgesics or nonsteroidal anti-inflammatory medications. Moderate episodes are treated with antiemetics and migraine specific medications. More severe migraines often require parenteral medications and sometimes intravenous fluids. Prophylaxis involves adoption of a chronic disease model, identifying and avoiding triggers and causative factors for migraine, nonpharmacological methods such as dietary modification and biofeedback, and for some patients, pharmacological prophylaxis.