UMEM Educational Pearls

Title: What Makes a Headache a Migraine?

Category: Neurology

Keywords: migraine, headache, diagnosis, treatment, prevention (PubMed Search)

Posted: 11/11/2020 by WanTsu Wendy Chang, MD (Updated: 11/13/2020)
Click here to contact WanTsu Wendy Chang, MD

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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