Ciguatera fish poisoning (CFP) is a human food borne intoxication mainly due to the consumption of finfish contaminated with ciguatoxins (CTXs). Complexity and variability of such compounds have made difficult the development of reliable methods for their determination with the specificity and sensitivity required to be suitable for routine monitoring of CFP. The present review aims to describe the methodologies available for CTX detection including those based on toxicological, biochemical and chemical as well as pharmaceutical properties of CTXs. Selecting any of these methodological approaches in a routine monitoring of ciguatera may be dependent on the applicability of the method. However, identifying a reference validated method for CTXs is a critical and urgent issue, and is dependent on the availability of CTXs certified standards and coordinated action among laboratories. Reports of CFP cases of intoxication in European hospitals have been described in several countries, mostly due to travel to CFP areas. Additionally, the recent detection of the tropical genus Gambierdiscus in the eastern Atlantic Ocean in the northern hemisphere and in the Mediterranean Sea, as well as the confirmation of CFP in the Canary Islands, and possibly in Madeira, constitute additional reasons to study the onset of CFP in Europe]. The question of the possible contribution of climate change on the distribution of toxin-producing microalgae and ciguateric fish is raised. Regarding European Union regulations on marine toxins in seafood products, the impact of ciguatera onset on EU policies will be discussed; critical analysis and availability of current methodologies for CTX determination is required in order to rapidly respond to suspected cases of CFP and to conduct sound work on CFP risk analysis.