Migraine headache in adults

Last reviewed: 28 Apr 2022
Last updated: 28 Apr 2022

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
More key diagnostic factors

Other diagnostic factors

  • vomiting
  • unilateral
  • throbbing sensation
Other diagnostic factors

Risk factors

  • family history of migraine
  • female sex
  • obesity
  • stressful life events
  • medication overuse
  • sleep disorders
  • low socio-economic status
  • allergies or asthma
  • hypothyroidism
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • erythrocyte sedimentation rate (ESR)
  • lumbar puncture (LP)
  • cerebrospinal fluid (CSF) culture
  • MRI brain
  • CT head
  • angiography
More investigations to consider

Treatment algorithm

INITIAL

patient presenting to the emergency department with persistent migraine

ACUTE

mild to moderate symptoms: non-pregnant

severe symptoms: non-pregnant

pregnant

ONGOING

frequent recurring severe/disabling symptoms: non-pregnant

frequent recurring severe/disabling symptoms: pregnant

Contributors

Authors

Timothy A. Collins, MD

Associate Professor of Neurology

Chief

Headache Division

Department of Neurology

Duke University Medical Center

Durham

NC

Disclosures

TAC served as a paid consultant for Alphasights (a global healthcare consulting organization) in 2017 and 2018 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.

Acknowledgements

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

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.

  • Differentials

    • Headache, tension
    • Headache, cluster
    • Medication-overuse headache
    More Differentials
  • Guidelines

    • Headaches in over 12s: diagnosis and management
    • The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice
    More Guidelines
  • Patient leaflets

    Migraine

    Migraines: questions to ask your doctor

    More Patient leaflets
  • Videos

    Diagnostic lumbar puncture in adults: animated demonstration

    Peripheral venous cannulation animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer