Migraine: diagnosis and management


  • Funding: The work of P. J. Goadsby was supported by the Wellcome Trust and the Migraine Trust.

    Conflicts of interest: None

P. J. Goadsby, Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom. Email: peterg@ion.ucl.ac.uk



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 anti-­inflammatory 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)