[Migraine: from generic recommendations to practical taking in charge]

Abstract

Although with an 11% prevalence migraine is a major public health problem, many patients are not satisfied with its handling by medical professionals. Migraine is a clinical diagnosis based on typically lateralized throbbing headache with nausea and/or photo- and phonophobia. It can in some be preceded by an aura with transient focal neurological symptoms. There are several "red flags" of clinical presentation, however, that should induce further examination with brain imaging studies. Treatment is based on identifying and avoiding provoking factors, on treating attacks with rescue medication (simple pain killers or triptans), on identifying conditions for a prophylactic treatment by one of several possible substance classes, and most importantly, on establishing a solid therapeutic relationship with the patient.