Migraine headache in adults

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Última revisión: 11 Dec 2025

Última actualización: 07 Mar 2025

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.

Definición

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][2]

Anamnesis y examen

Principales factores de diagnóstico

prolonged headache
nausea and/or vomiting
decreased ability to function
headache worse with activity
sensitivity to light
sensitivity to noise
unilateral
throbbing sensation
aura

Todos los datos

Factores de riesgo

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

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

clinical diagnosis

Todos los datos

Pruebas diagnósticas que deben considerarse

erythrocyte sedimentation rate (ESR)
c-reactive protein (CRP)
lumbar puncture (LP)
cerebrospinal fluid (CSF) culture
MRI brain
CT head
angiography

Todos los datos

Algoritmo de tratamiento

Inicial

presenting to the emergency department with persistent migraine

Agudo

mild symptoms: nonpregnant

moderate to severe symptoms: nonpregnant

pregnant

En curso

frequent recurring severe/disabling symptoms not linked to menstrual cycle: nonpregnant

frequent recurring severe/disabling symptoms linked to menstrual cycle: nonpregnant

frequent recurring severe/disabling symptoms: pregnant

Colaboradores

Autores

Timothy A. Collins, MD

Associate Professor of Neurology

Chief

Headache Division

Department of Neurology

Duke University Medical Center

Durham

Divulgaciones

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.

Agradecimientos

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

Divulgaciones

AD declares that she has no competing interests.

Revisores por pares

Anne Walling, MD

Professor

Family and Community Medicine

University of Kansas School of Medicine

Wichita

Divulgaciones

AW declares that she has no competing interests.

Marc S. Husid, MD

Director

Walton Headache Center

Augusta

Divulgaciones

MSH declares that he has no competing interests.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Ailani J, Burch RC, Robbins MS, et al. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache. 2021 Jul;61(7):1021-39.Texto completo Resumen

Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol. 2021 Aug;17(8):501-14.Texto completo Resumen

Becker WJ, Findlay T, Moga C, et al. Guideline for primary care management of headache in adults. Can Fam Physician. 2015 Aug;61(8):670-9.Texto completo Resumen

Worthington I, Pringsheim T, Gawel MJ, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5 suppl 3):S1-80.Texto completo Resumen

VanderPluym JH, Halker Singh RB, Urtecho M, et al. Acute treatments for episodic migraine in adults: a systematic review and meta-analysis. JAMA. 2021 Jun 15;325(23):2357-69.Texto completo Resumen

Orr SL, Friedman BW, Christie SC, et al. Management of adults with acute migraine in the emergency department: the American Headache Society evidence assessment of parenteral pharmacotherapies. Headache. 2016 Jun;56(6):911-40.Texto completo Resumen

Silberstein SD, Holland S, Freitag F, et al; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1337-45.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Tension-type headache (TTH)
- Cluster headache
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Guías de práctica clínica
- Prevention of episodic migraine headache using pharmacologic treatments in outpatient settings: a clinical guideline from the American College of Physicians
- The international classification of headache disorders, 3rd edition
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Folletos para el paciente
Migraine
Migraines: questions to ask your doctor
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Migraine headache in adults

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

presenting to the emergency department with persistent migraine

mild symptoms: nonpregnant

moderate to severe symptoms: nonpregnant

pregnant

frequent recurring severe/disabling symptoms not linked to menstrual cycle: nonpregnant

frequent recurring severe/disabling symptoms linked to menstrual cycle: nonpregnant

frequent recurring severe/disabling symptoms: pregnant

Colaboradores

Autores

Timothy A. Collins, MD

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Anne Walling, MD

Divulgaciones

Marc S. Husid, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Videos

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice