Conclusions

The 1990s have seen a number of important developments that have led to progress in our understanding and treatment of migraine.

The first step was the agreed classification of headache by the International Headache Society. As a result, diagnosis is now more uniform and research studies more consistent. Supported by validated methods such as MIDAS for assessing the degree of disability, the doctor is in a much better position to help people at the individual level. On the strength of these developments, people with migraine should feel encouraged to seek help from their GP, who can now help them more than ever before.

On the medicines front, we are now in the era of the triptans, which mark an important advance in migraine treatment. The availability of triptans with different attributes provides choice to both patients and doctors and the opportunity to find the appropriate treatment.

Of course, there are still unresolved problems. In acute treatment, patients may experience an initial response to a medicine only to be find that the headache quickly returns. This probably happens because there are disturbances in the brain which continue after the medicine has been eliminated from the body.

In the area of migraine prevention, improved therapies are also needed, especially for people who have heart and respiratory problems. These may come from the important advances in identifying the genetic factors that underlie migraine. As these are better understood, they will provide new targets for medicines design with the ultimate possibility of understanding the biochemical basis of the trigger threshold and possibly complete control of attacks.

Overall progress has been significant, and although migraine remains a highly individual disorder in terms of trigger factors and symptoms, relief can already be provided for the majority of patients. It seems likely that this will continue with new and more effective approaches emerging in the first decade of the 21st century.