Migraine. II. Treatment

THE MOST useful therapeutic tool in the treatment of a patient with chronic headache is the establishment of a trusting relationship between physician and patient. The physician must convey a genuine interest in the patient's distress, giving the patient ample time to discuss his symptoms and the social and emotional disruptions that either promote the symptoms or arise as a result of them. Because the headache sufferer is often anxious and frightened, a full explanation of the diagnostic and treatment approach can help allay inappropriate fear. Unfounded or premature emphasis on emotional factors as a cause of the headaches must be avoided, lest it encourage a defensive posture toward the physician and prevent the development of the confidence necessary for successful treatment. NONMEDICAL TREATMENT Isolating Triggering Factors Migraine can be viewed as a genetically determined physiologic predisposition that is influenced by a wide variety of emotional, biological, and constitutional factors,