Several studies have examined patients' attitudes to a consultation fo
r migraine and other headaches. However, a patient's assessment of the
problem for which they seek treatment may differ from that of the ref
erring primary physician which may, in turn, differ from the specialis
t's. This study sat out to examine this triangle. The commonest reason
for referral was failure of treatment response. This contrasted with
the patient's different perception-an increase in the frequency of att
acks which we saw as headaches additional to migraine, accounting for
failed treatment. Similarly, our view of the patient wanting reassuran
ce paralleled their request for further information. These findings co
nfirmed the hypothesis that recognizing and understanding a patient's
fears were important factors towards a favorable outcome of a consulta
tion.