Migraine is a chronic, genetically determined, episodic, neurologic disorder that usually presents in early-to-mid life.
Patients complain of intermittent headache and associated symptoms, such as visual disturbance, nausea, vomiting, and sensitivity to light or noise (photophobia and phonophobia).
The diagnosis is based on history and physical exam. No laboratory or imaging tests are essential for diagnosis.
Treatment approaches involve identification and avoidance of trigger factors, and the use of medication to treat the acute attack or prevent future attacks.
There are no clinical trials that identify one migraine therapy (acute therapy or prophylaxis therapy) as superior over others. Triptans in general are preferred over nonspecific treatments. However, there are no trials directly comparing triptans.
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 occurs during or precedes headache, is pathognomonic of migraine but only occurs in 15% to 30% of patients.  
Associate Professor of Neurology
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.
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