Appendix 1 : Guidelines on the Management of Migraine

There are four elements to good migraine management:

• correct and timely diagnosis

• reassurance

• predisposition / trigger identification and avoidance

• intervention (drug or non-drug)

Confirm that the diagnosis is correct! Migraine with aura is readily diagnosed - the headache is preceded by transient hemianopic disturbance, a spreading scintillating scotoma, or transient sensory or dysphasia symptoms usually involving the  face or arm, (but rarely the leg).

Migraine without aura may be more difficult to diagnose: the International Headache Society criteria include the following:

Headaches having at least two of the following characteristics

• unilateral location

• pulsating quality

• moderate or severe intensity

• aggravation by routine physical activity

and during headache at least one of the following:

• nausea and/or vomiting or diarrhoea

• photophobia and phonophobia

Every day headache is not a simple migraine.  Some patients may develop chronic daily headaches in association with pre-existing migraine as a result of excessive analgesic usage (medication overuse headache), and it is important to identify this group.