The use of questionnaires based on IHS criteria have proved to be useful in general practice 2. The patient is advised about external triggers of attacks A number of external factors may trigger attacks, and the knowledge of the patient about these is important. Pharmaceutical treatment is based on a sequential trial of active substances doses and formulation. The safest, best known and cheapest drugs should be tried first. A paper in the Lancet 1995 showed 900 mg of acetylic acid combined with 10 mg of metoclopramide to be as effective as a tablet of 100 mg sumatriptane.
Treatment takes unwanted side effects into account.
All analgesics may produce headache after some time of regular use. This is preventable or treatable and deserves greater attention from practitioners. Migraine patients are referred to a specialist in the event of diagnostic doubt, suspicion of serious underlying disease or treatment failure. Optimal use of resources at a high competence level requires active co-operation between primary and secondary lines of care. Most general practitioners need decision support to make a correct diagnosis of migraine.