Migraine headache in adults

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 report 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 should be individualized, taking into account patient characteristics, preferences, and goals. Management involves identifying and avoiding trigger factors, and the use of medication and nonpharmacologic therapies to treat the acute attack and to prevent future attacks.

Migraine-specific treatments such as triptans, lasmiditan, and calcitonin gene-related peptide (CGRP) antagonists, are preferred over nonspecific treatments. Noninvasive neuromodulation is a newer treatment for acute moderate to severe symptoms.

Preventive therapies with established efficacy include anticonvulsants, beta-blockers, CGRP antagonists, and botulinum toxin.

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.[1]Hadjikhani N, Sanchez Del Rio M, Wu O, et al. Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci USA. 2001 Apr 10;98(8):4687-92. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC31895 http://www.ncbi.nlm.nih.gov/pubmed/11287655?tool=bestpractice.com [2]Bashir A, Lipton RB, Ashina S, et al. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013 Oct 1;81(14):1260-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795609 http://www.ncbi.nlm.nih.gov/pubmed/23986301?tool=bestpractice.com

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