Background: Migraine is a genetically determined recurrent pain syndrome accompanied by neurological and gastrointestinal features, involving interaction of external triggers and internal pathophysiology and the cause of considerable disability to sufferers.
Objective: This article discusses the pathophysiology and diagnosis of migraine and outlines a patient centred approach to management.
Discussion: Establishing the correct diagnosis is essential for success. Discussing a structured approach ("a puff, a gust, and a gale") in the recognition of a developing migraine attack can assist patients in appropriate self management. A "stepped care" approach to management of acute migraine involves initial nonpharmacological methods followed by antiemetics and simple analgesics or nonsteroidal anti-inflammatory medications. Moderate episodes are treated with antiemetics and migraine specific medications. More severe migraines often require parenteral medications and sometimes intravenous fluids. Prophylaxis involves adoption of a chronic disease model, identifying and avoiding triggers and causative factors for migraine, nonpharmacological methods such as dietary modification and biofeedback, and for some patients, pharmacological prophylaxis.