International Headache Society Standards
Much of this recent success stems from formal work doneon the study of headache. In 1988, the International Headache Society proposedclassification and diagnostic criteria for headache disorders and facialpain. I was involved with one of the committees that formulated the classification.This international endeavor developed uniform rules to diagnose migraineas well as other headache disorders. Prior to that time the diagnosticstandards for classifying headache were less exact. The revised classificationproposed by worldwide medical scientists working with headache patientspermitted physicians to study pharmacologic agents (drugs) in similar patients.Patients’ symptoms would have to meet diagnostic criteria that would enablephysicians in different countries, speaking different languages, to includesimilar patients suffering from the same migraine disorder into investigativestudies with drugs.
These diagnostic standards allowed study of the effectivenessand adverse effects of drugs on an international scale. The past elevenyears since the Classification was proposed have seen the development ofseveral novel pharmacologic agents which other physicians and I are nowusing to treat migraine. The drugs have been tested with large numbersof patients and their effectiveness has been satisfactorily demonstratedto meet scientific standards. Drugs formerly used for other disorders werealso satisfactorily effective for migraine using these new diagnostic criteria.Furthermore, one over-the-counter compound was designated as effectivein migraine. The same diagnostic standards were used in this investigativestudy and this commonly used over-the-the counter analgesic now has FDAapproval for use in migraine with and without aura.
Pharmacologic Advances
What new agents are available for treatment and preventionof migraine? What can we look forward to in the future?
Many compounds have demonstrated effectiveness in scientificstudies but only a few have received governmental endorsement. FDA approvalis based on having a sufficient number of controlled studies and a consensusof informed individuals agreeing that a particular drug could be marketedfor a specific indication (eg, for the treatment of migraine).
