Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- prolonged headache
- nausea
- decreased ability to function
- headache worse with activity
- sensitivity to light
- sensitivity to noise
- aura
Risk factors
- family history of migraine
- high caffeine intake
- exposure to change in barometric pressure
- female sex
- obesity
- stressful life events
- overuse of headache medications
- sleep disorders
- low socio-economic status
- allergies or asthma
- hypertension
- hypothyroidism
- diet
Diagnostic investigations
Investigations to consider
- erythrocyte sedimentation rate (ESR)
- lumbar puncture (LP)
- cerebrospinal fluid (CSF) culture
- MRI brain
- CT head
Treatment algorithm
Contributors
Authors
Associate Professor of Neurology
Chief
Headache Division
Department of Neurology
Duke University Medical Center
Durham
NC
Disclosures
TAC was an unpaid site principal investigator for the Alder study ALD403-CLIN-011 (monoclonal Ab against CGRP as treatment for chronic migraine), which ended in July 2017. TAC served as a paid consultant for Eli Lilly Co. in November 2016. In 2017 and 2018 he served as a paid consultant for Alphasights, a global healthcare consulting organization, regarding migraine headache diagnosis and treatment. He provides expert testimony for legal cases regarding headache disorders and treatment (approximately one case per year). TAC is an author of several references cited in this topic.
Dr Timothy Collins would like to gratefully acknowledge Dr Ann Donnelly, the previous contributor to this topic.
Disclosures
AD declares that she has no competing interests.
Peer reviewers
Professor
Family and Community Medicine
University of Kansas School of Medicine
Wichita
KS
Disclosures
AW declares that she has no competing interests.
Director
Walton Headache Center
Augusta
GA
Disclosures
MSH declares that he has no competing interests.
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