Making a clinical diagnosis is a thought process but we do not know ho
w we remember, let alone think. Migraine attacks are dynamic, with sym
ptoms evolving, progressing and regressing during 4-72 h. Some of us a
ttempt to abstract criteria from this ''drama'', others try to see the
whole ''play'' as a stage performance. However, we are dependent on p
atients' descriptions and must carefully evaluate the responses to our
questions. Describing pain quality-translating feelings into words-is
especially difficult. Patients can be led or misled by questions, par
ticularly if posed by insensitive questioners applying rigid criteria.
Nevertheless, criteria are essential for the inclusion or exclusion o
f patients in drug trials or a series when special investigations are
being conducted, but not in a difficult diagnostic case when there are
two concomitant headaches or when trying to help someone cope with mi
graine.