• Migraine is the 2nd most common neurologic disorder after tension headache and accounts for more disability than all other neurologic disorders combined.
• Diagnosis is clinical and defined by at least 5 episodes of headache that meet the following criteria:
  • Duration of 4 to 72 hours (when untreated or unsuccessfully treated)
  • At least 2 characteristics: unilateral, pulsating, moderate-to-severe pain intensity, aggravated by physical activity
  • Accompanied by at least 1 symptom: nausea, vomiting, photophobia, phonophobia
• Aura symptoms must be fully reversible and may be visual, sensory, speech/language, motor, brainstem, or retinal.
• Early treatment while the headache is still mild include NSAIDs followed by triptans.
  • Opioids and barbiturates are not recommended due to adverse effects and risk of dependency.
• Preventive treatment is recommended for patients who have at least 2 migraine days per month and whose lives are adversely affected.
  • Common therapies include antihypertensive agents (e.g. propranolol), antidepressants (e.g. amitriptyline), anticonvulsants (e.g. topiramate, valproate), and calcium-channel blockers (flunarizine).

Bottom Line: Migraine is a common and debilitating condition that benefits from early treatment. Consider initiating preventive therapy for patients who experience at least 2 migraine days per month and adverse effects despite treatment.

References

• Ashina M. Migraine. N Engl J Med. 2020;383(19):1866-76.

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