Four steps in managing migraine.

The first step in management of migraine is convincing the patient of the diagnosis. Once this has been accomplished, the physician needs to identify precipitating factors. Common migraine triggers include stress, menstruation, use of oral contraceptives, and certain foods. The next step is choosing appropriate therapy. Analgesics are most commonly prescribed in North America; nonsteroidal antiinflammatory drugs, ergotamine, narcotics, corticosteroids, and other drugs are also useful. Prophylactic therapy should be considered when treatment of individual attacks fails, causes adverse effects, or leads to dependence.