The clinical diagnosis of migraine: the beginning of therapy.

Clear symptoms and signs are found in patients during severe migraine attacks. Diagnostic difficulties are encountered in eliciting this episodic clinical picture. A label of migraine, however, is only the beginning: factors that precipitate attacks, fears aroused in the migraineur and the failure, or partial efficacy, of acute and prophylactic therapy need also to be determined. If migraine is complicated by an additional headache, the analysis becomes more difficult, but the diagnosis still has to be accurate. This, however, is not always possible at the initial interview. A successful consultation should be more than just diagnostic; it is the beginning of treatment.