Migraine is a chronic, genetically determined, episodic, neurologic disorder that usually presents in early-to-mid life. It can have a severe effect on quality of life, but it is often under-diagnosed and under-treated.
Patients complain of intermittent headache and associated symptoms, such as visual disturbance, nausea, vomiting, and sensitivity to light or noise (photophobia and phonophobia).
Some women experience menstrual migraine, which is most likely to occur in the 2 days leading up to a period and in the first 3 days of a period.
Diagnosis is based on history and physical exam. No laboratory or imaging tests are essential for diagnosis.
Treatment approaches involve identifying and avoiding trigger factors, and the use of medication to treat the acute attack or prevent future attacks. Triptans are preferred over nonspecific treatments.
Complications include status migrainosus, migrainous infarction, chronic migraine, persistent aura without infarction and seizures, analgesic gastropathy, transformation of episodic to chronic migraine, and medication-overuse headache.
Migraine is a chronic, genetically determined, episodic neurologic disorder that usually presents in early-to-mid life. Key features in the history that support a diagnosis of migraine are nausea, photophobia, and disability, along with headache. Typical migraine aura (a complex of reversible visual, sensory, or speech symptoms), which precedes or occurs during headache, is pathognomonic of migraine but occurs only in 15% to 30% of patients.
History and exam
Timothy A. Collins, MD
Associate Professor of Neurology
Department of Neurology
Duke University Medical Center
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.
AD declares that she has no competing interests.
Anne Walling, MD
Family and Community Medicine
University of Kansas School of Medicine
AW declares that she has no competing interests.
Marc S. Husid, MD
Walton Headache Center
MSH declares that he has no competing interests.
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