Migraine is a chronic, episodic, neurologic disorder that has a strong genetic component and 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 and to prevent future attacks. Triptans are preferred over nonspecific treatments.
Migraine is a chronic, episodic neurologic disorder that has a strong genetic component and usually presents in early-to-mid life. Key features in the history that support a diagnosis of migraine are nausea, photophobia, and reduced ability to function, 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
Key diagnostic factors
- prolonged headache
- decreased ability to function
- headache worse with activity
- sensitivity to light
- sensitivity to noise
Other diagnostic factors
- throbbing sensation
- family history of migraine
- female sex
- stressful life events
- medication overuse
- sleep disorders
- low socioeconomic status
- allergies or asthma
1st investigations to order
- clinical diagnosis
Investigations to consider
- erythrocyte sedimentation rate (ESR)
- lumbar puncture (LP)
- cerebrospinal fluid (CSF) culture
- MRI brain
- CT head
patient presenting to the emergency department with persistent migraine
mild to moderate symptoms: nonpregnant
severe symptoms: nonpregnant
frequent recurring severe/disabling symptoms: nonpregnant
frequent recurring severe/disabling symptoms: pregnant
- Headache, tension
- Headache, cluster
- Medication-overuse headache
- Headaches in pregnancy and postpartum: ACOG clinical practice guideline no. 3
- The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice
Migraines: questions to ask your doctorMore Patient leaflets
Diagnostic lumbar puncture in adults: animated demonstration
Peripheral venous cannulation: animated demonstrationMore videos
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