Migraine has been described as ‘‘a
chronic disorder that afflicts many millions,
pursues a highly variable and unpredictable
clinical course, is quite likely
polygenetic and susceptible to epigenetic
factors, and is accompanied by a
plethora of comorbid conditions that
may influence its clinical expression and
complicate its treatment.’’1 Despite the
need for therapy for this common and
disabling condition, migraine in the
United States remains both underdiagnosed
and undertreated.2 The American
Migraine Prevalence and Prevention
Study found that just over half of questionnaire-
diagnosed severe migraine
patients in the United States had ever
received a formal diagnosis.2 Although
most were using some form of abortive
therapy, only 12% were on dedicated
preventive management.
Diagnostic information and reassurance
are rarely all that the patient is
seeking from a clinical evaluation of
headache; most are seeking some sort
of relief. Goals of treatment include
restoration of function, reduction of
disability and suffering, and, possibly,
reduction in disease progression and
future expression. Treatment often centers
on pharmacotherapy, but it can
include a host of medication, nonmedication,
alternative, and interventional
therapies and their combinations.