DIAGNOSIS AND OPTIMUM TREATMENT OF MIGRAINE

In the last few years, several advances have been made in the area of migraine. Characterisation of the serotonin (5-hydroxytryptamine; 5-HT) receptor that belongs to the 5-HT1 class and mediates selective cranial vessel vasoconstriction has provided the impetus for mechanistic, clinical and therapeutic studies in migraine. The interest in migraine mechanisms has resulted in considerable clinical development, particularly in the field of diagnosis, with the advent of a set of diagnostic criteria that are widely accepted. The criteria of the International Headache Society are easily applied and provide a useful practical tool in headache diagnosis. Prophylactic therapy of migraine still depends on old, clinically useful but largely systematically unproven drugs such as propranolol, flunarizine, methysergide, pizotifen and amitriptyline. In contrast, substantial advances have been made recently in the treatment of acute attacks of migraine, with the introduction of the 5-HT1-like receptor agonist, sumatriptan. This drug is both effective and rapid in its onset of effect and is associated with minimal adverse effects. Many patients with migraine are equally well treated by older drugs such as aspirin (acetylsalicylic acid), nonsteroidal anti-inflammatory agents or ergotamine derivatives. The future development of drugs in neurology will hopefully follow that of migraine, so that advances in therapeutics will be paralleled by an increased understanding of a condition and/or better diagnosis.