Migraine is an underdiagnosed and undertreated disorder. This can be a
ttributed to the low consultation rate for migraine, for which many re
asons have been proposed. These include the fact that many migraineurs
self-treat and, historically, the lack of available effective treatme
nts. Some migraineurs are referred to specialist centers for advice. T
hese patients do not merely need effective pain relief. They also need
an explanation of the cause of the migraine and reassurance that thei
r headache pain does not have a more sinister cause. By spending time
with patients and taking a full history of their migraine condition, t
he physician can propose a management strategy that is appropriate to
each individual patient, thus providing a tailored-care approach. Thor
ough exploration of possible trigger factors for migraine and advice o
n avoidance may help to reduce attack frequency. Simple techniques can
also be used to improve compliance with prescribed therapies. For exa
mple, it is important for the physician to establish that the patient
understands any instructions given and to reinforce this advice at fol
low-up visits. Regular follow-up is important because it enables manag
ement strategies to be evaluated and helps the patients to feel involv
ed in the management of their migraine. A correct understanding of the
way a drug works and the nature of the condition, together with an ex
planation of any potential side effects, is likely to maximize clinica
l benefit.