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Migraine headache in adults

Last reviewed: 10 Sep 2024
Last updated: 28 Nov 2023

Summary

Definition

History and exam

Key diagnostic factors

  • prolonged headache
  • nausea
  • decreased ability to function
  • headache worse with activity
  • sensitivity to light
  • sensitivity to noise
  • aura
Full details

Other diagnostic factors

  • vomiting
  • unilateral
  • throbbing sensation
Full details

Risk factors

  • family history of migraine
  • female sex
  • obesity
  • stressful life events
  • medication overuse
  • sleep disorders
  • low socioeconomic status
  • allergies or asthma
  • hypothyroidism
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • erythrocyte sedimentation rate (ESR)
  • lumbar puncture (LP)
  • cerebrospinal fluid (CSF) culture
  • MRI brain
  • CT head
  • angiography
Full details

Treatment algorithm

INITIAL

patient presenting to the emergency department with persistent migraine

ACUTE

mild to moderate symptoms: nonpregnant

severe symptoms: nonpregnant

pregnant

ONGOING

frequent recurring severe/disabling symptoms: nonpregnant

frequent recurring severe/disabling symptoms: pregnant

Contributors

Authors

Timothy A. Collins, MD

Associate Professor of Neurology

Chief

Headache Division

Department of Neurology

Duke University Medical Center

Durham

NC

Disclosures

TAC provides expert testimony for legal cases regarding headache disorders and treatment (approximately one or two cases per year). TAC is an author of several references cited in this topic.

Acknowledgements

Dr Timothy Collins would like to gratefully acknowledge Dr Ann Donnelly, the previous contributor to this topic.

Disclosures

AD declares that she has no competing interests.

Peer reviewers

Anne Walling, MD

Professor

Family and Community Medicine

University of Kansas School of Medicine

Wichita

KS

Disclosures

AW declares that she has no competing interests.

Marc S. Husid, MD

Director

Walton Headache Center

Augusta

GA

Disclosures

MSH declares that he has no competing interests.

  • Differentials

    • Headache, tension
    • Headache, cluster
    • Medication overuse headache
    More Differentials
  • Guidelines

    • ACR Appropriateness Criteria: headache
    • Headaches in pregnancy and postpartum: ACOG clinical practice guideline no. 3
    More Guidelines
  • Patient information

    Migraine

    Migraines: questions to ask your doctor

    More Patient information
  • Videos

    Diagnostic lumbar puncture in adults: animated demonstration

    Peripheral intravascular catheter: animated demonstration

    More videos
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