title: Migraine: assessment and management.
abstract: Headaches occur at some time in the vast majority of the population. For most people headaches are a nuisance but for some they can be disabling. Two per cent of the population at any time have chronic daily headache, with or without analgesic dependence, but most disabling headaches are intermittent and migranous in nature. Before hoping to make an appropriate intervention, an accurate diagnosis must be made. The first part of this paper examines the differential diagnosis and in particular separates benign from sinister, acute from chronic and tension-type from migranous. The second half focuses on the management of migraine. An individualised approach is usually the most effective, with the patient drawing from the broad areas of attention to trigger factors and lifestyle, finding an acute or rescue medication that consistently returns them to normal activities within a few hours, and prophylaxis to reduce the rate of attack by 50% in those with high frequency migraine. The expession of migraine may well vary during an individual's life and in order to achieve the best lifelong control, adjustment of the blend of management options may be needed. The aim of the adviser is to enable patients to feel in control of their migraine rather than feeling that migraine controls them.
authors.affiliation: King's Headache Service, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Dowson
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis* / Q000188:drug therapy; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D017366:Serotonin Receptor Agonists