Treatment of migraine

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Editor, – Accompanying Associate Professor Andrew Somogyi's article 'Pethidine is inappropriate for migraine' (Aust Prescr 1997;20:71) is an insert recommending the treatment of acute migraine based on 'Therapeutic Guidelines: Neurology' by Therapeutic Guidelines Ltd. In it, patients are advised to rest, etc., but no mention is made of what posture they should adopt while resting. It is important that they rest sitting up, or at least propped up as high as possible on pillows, as migraine is commonly aggravated by lying flat.

R.J. O'Bryan
General Practitioner
St. Kilda, Vic.

Benafsha Khariwala, the Managing Editor of Therapeutic Guidelines Ltd, comments:
The treatment of the acute attack of migraine is complex and subject to considerable variability between patients. One could argue theoretically for different positions to try to alter cerebral blood flow; however, in the acute phase of an attack, patients are photophobic and nauseated and patient comfort is an important factor in management. As many patients are also dizzy at this time, lying down is usually their preferred position. Other patients may find different positions to be more comfortable. We do not believe any one position is appropriate for all patients.