• Several medications such as dopamine-blocking anti-emetics, triptans, and ergotamine derivatives have been shown to more effectively treat migraine headaches over other types of headaches, making the ability to accurately recognize this common (2.2% of all ED visits) condition essential.

 

• According to the International Headache Society, one meets diagnostic criteria for migraine headache without aura when they have experienced at least 5 attacks, each lasting 4 to 72 hours (untreated or unsuccessfully treated) and accompanied by at least 2 of the 4 following characteristics ("PUMA"):

          A.

              1.  Pulsatile or throbbing in quality

              2.  Unilateral in location

              3.  Moderate to severe in intensity

              4.  Aggravated by activity (i.e.climbing stairs, exertion), plus

         B.  at least 1 of the following 2 during the headache  ("VP"): 

              1.  Vomiting and/or nausea

              2.  Photophobia and/or phonophobia

    

References

• Goadsby EJ, et al. "Migraine: Current Understanding and Treatment." New Engl Journal of Medicine 2002;346:257-270.
• Kostic MA et al.  "A Prospective, Randomized Trial of Intravenous Prochlorperazine Versus Subcutaneous Sumatriptan in Acute Migraine Therapy in the Emergency Department." Annals of Emergency Medicine 2010; 56;1:1-6.