Diagnosis and management of migraine headaches.

Migraine headaches afflict approximately 6% of men and 18% of women in the United States, and cost billions of dollars each year in lost productivity, absenteeism, and direct medical expendi tures. Despite its prevalence and the availability of therapeutic op tions, many patients do not seek treatment, and among those who do, a significant portion are misdiagnosed. Correct diagnosis can be made by identifying the historic and physical examination finding that distinguish primary headache disorders from secondary head ache disorders, as well as the key clinical features that distinguis migraine headaches from other types. Once diagnosis is made, im proper or inadequate management of headache pain, related symp toms such as nausea, and the possible aggravating side-effects of pharmacologic therapies represent further obstacles to effective ther apy. Dissatisfaction with migraine therapy on the basis of these factors is common. Among abortive therapy options there are de livery methods available which may avoid aggravating symptom such as nausea. Recommended pharmacologic agents include non steroidal anti-inflammatory drugs, intranasal butorphanol, ergota mine and its derivatives, and the triptans. Indications for prophylac tic in addition to abortive therapy include the occurrence o headaches that require abortive therapy more than twice a week, tha do not respond well to abortive therapy, and which are particularly severe. Research is ongoing in the pathophysiology of migraines evaluation of nonpharmacologic treatment modalities, assessment of new drug therapies, and validation of headache guidelines.