Last reviewed: June 2020
Last updated: March  2020



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
  • habitual snoring
  • stressful life events
  • overuse of headache medications
  • lack of sleep
  • 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
  • CT head
  • MRI brain
More investigations to consider

Treatment algorithm


Associate Professor of Neurology


Headache Division

Department of Neurology

Duke University Medical Center




TAC was an unpaid site PI 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 he served as a paid consultant for Alphasights, a global healthcare consulting organization, regarding migraine headache diagnosis and treatment. He has provided expert testimony regarding headache disorders for a legal case in 2015, and expects to be paid to provide expert testimony on headache disorders in 2018 for a legal case relating to the diagnosis, treatment, and standard of care for headache disorders.

Dr Timothy Collins would like to gratefully acknowledge Dr Ann Donnelly, the previous contributor to this monograph. AD declares that she has no competing interests.

Peer reviewersVIEW ALL


Family and Community Medicine

University of Kansas School of Medicine




AW declares that she has no competing interests.


Walton Headache Center




MSH declares that he has no competing interests.

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