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Migraine headache in adults

最后审阅: 17 Aug 2025
最后更新: 07 Mar 2025

小结

定义

病史和体格检查

关键诊断因素

  • prolonged headache
  • nausea and/or vomiting
  • decreased ability to function
  • headache worse with activity
  • sensitivity to light
  • sensitivity to noise
  • unilateral
  • throbbing sensation
  • aura
完整详情

危险因素

  • family history of migraine
  • female sex
  • obesity
  • stressful life events
  • medication overuse
  • sleep disorders
  • low socioeconomic status
  • allergies or asthma
  • hypothyroidism
完整详情

诊断性检查

首要检查

  • clinical diagnosis
完整详情

需考虑的检查

  • erythrocyte sedimentation rate (ESR)
  • c-reactive protein (CRP)
  • lumbar puncture (LP)
  • cerebrospinal fluid (CSF) culture
  • MRI brain
  • CT head
  • angiography
完整详情

治疗流程

初步治疗

presenting to the emergency department with persistent migraine

急症处理

mild symptoms: nonpregnant

moderate to severe symptoms: nonpregnant

pregnant

持续性治疗

frequent recurring severe/disabling symptoms not linked to menstrual cycle: nonpregnant

frequent recurring severe/disabling symptoms linked to menstrual cycle: nonpregnant

frequent recurring severe/disabling symptoms: pregnant

撰稿人

作者

Timothy A. Collins, MD

Associate Professor of Neurology

Chief

Headache Division

Department of Neurology

Duke University Medical Center

Durham

NC

利益声明

TAC provides expert testimony for legal cases regarding headache disorders and treatment (approximately one or two cases per year). TAC is an author of several references cited in this topic.

鸣谢

Dr Timothy Collins would like to gratefully acknowledge Dr Ann Donnelly, the previous contributor to this topic.

利益声明

AD declares that she has no competing interests.

同行评议者

Anne Walling, MD

Professor

Family and Community Medicine

University of Kansas School of Medicine

Wichita

KS

Disclosures

AW declares that she has no competing interests.

Marc S. Husid, MD

Director

Walton Headache Center

Augusta

GA

Disclosures

MSH declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Ailani J, Burch RC, Robbins MS, et al. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache. 2021 Jul;61(7):1021-39.Full text  Abstract

Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol. 2021 Aug;17(8):501-14.Full text  Abstract

Becker WJ, Findlay T, Moga C, et al. Guideline for primary care management of headache in adults. Can Fam Physician. 2015 Aug;61(8):670-9.Full text  Abstract

Worthington I, Pringsheim T, Gawel MJ, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5 suppl 3):S1-80.Full text  Abstract

VanderPluym JH, Halker Singh RB, Urtecho M, et al. Acute treatments for episodic migraine in adults: a systematic review and meta-analysis. JAMA. 2021 Jun 15;325(23):2357-69.Full text  Abstract

Orr SL, Friedman BW, Christie SC, et al. Management of adults with acute migraine in the emergency department: the American Headache Society evidence assessment of parenteral pharmacotherapies. Headache. 2016 Jun;56(6):911-40.Full text  Abstract

Silberstein SD, Holland S, Freitag F, et al; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1337-45.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Tension-type headache (TTH)
    • Cluster headache
    • Medication overuse headache
    More Differentials
  • Guidelines

    • Prevention of episodic migraine headache using pharmacologic treatments in outpatient settings: a clinical guideline from the American College of Physicians
    • The international classification of headache disorders, 3rd edition
    More Guidelines
  • Patient information

    Migraine

    Migraines: questions to ask your doctor

    More Patient information
  • Videos

    Diagnostic lumbar puncture in adults: animated demonstration

    Peripheral intravascular catheter: animated demonstration

    More videos
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