Last reviewed: 30 Oct 2020
Last updated: 11 Aug 2020

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

Other diagnostic factors

  • vomiting
  • unilateral
  • throbbing sensation

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
More investigations to consider

Treatment algorithm

Contributors

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 reviewersVIEW ALL

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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