Migraine headache. Working for the best outcome

Migraine is a common hereditary disorder manifested by episodic headache, irritability, and gastrointestinal upset. The condition may be triggered by dietary, environmental, psychological, or pharmacologic factors. With proper diagnosis and judicious use of abortive and prophylactic therapy, patients often obtain excellent results.

Selection of patients--critical aspects

Proper selection of patients is the most critical aspect in designing clinical trials in migraine research. We establish specific research diagnostic criteria for the definition of migraine. Additional factors in patient selection, migraine frequency, duration, medications and previous treatments, are reviewed. Exclusion criteria and the mixed headache syndrome patient are discussed.

Diet and headache. Is there a link?

Diet has been implicated as a source of migraine since antiquity. Now, diet is thought of as one of many factors that can trigger migraine. Improved understanding of the migraine process and an attempt to delineate the most common causes of diet-precipitated migraine have resulted in a more rational treatment strategy. We recognize that a small group of patients will have migraine after ingesting certain foods with vasoactive properties or by missing a meal; thus, we suggest a nutritional course to limit this influence. The role of allergy in migraine is not yet determined and remains controversial.

Cold as an adjunctive therapy for headache

We report the results of a study conducted recently at the Diamond Headache Clinic, Chicago, on the effectiveness of application of cold as an adjunctive therapy for acute headache. Ninety clinic outpatients were divided evenly into three groups according to headache type--migraine, cluster, and mixed. They used the standard headache medication for two attacks and the standard medication plus application of cold with a reusable, frozen gel pack for two attacks. There was no significant difference in patient response to the gel pack by headache type. Seventy-one percent of patients considered the pack effective; 52% reported an immediate decrease in pain, and 63% reported an overall decrease in pain. Seventy-one percent of patients intended to use the gel pack in the future. Use of such gel packs, which are available commercially, does not damage the skin. Our study indicates that cold application does provide some symptomatic relief of headache; it may also offer psychological alleviation of the pain.