DIAGNOSING MIGRAINE - ARE THE CRITERIA VALID OR INVALID

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.