Preferred in patients with contraindications to vasoconstrictors Oral and intranasal formulations, and subcutaneous injection Pain generally involves the temporomandibular joint and temporal areas associated with symptoms when chewingĬommon duration of 30 minutes to seven hours typically bilateral nonpulsating mild to moderate intensity without limiting activity no nausea or vomitingīrief episodes of sharp, stabbing pain and trigeminal nerve face distribution Worse on awakening generally progressive aggravated by coughing, straining, or changing positionĬhronic headache with few features of migraine tends to occur daily hormone therapy and hormonal contraceptives are frequent culprits includes analgesic reboundĪntecedent head trauma vertigo, lightheadedness poor concentration and memory lack of energy irritability and anxietyĮxplosive onset of severe headache 10% preceded by sentinel headachesĪlmost exclusively in patients older than 50 years associated with tenderness of scalp or temporal artery and jaw claudication visual changes Occipital location tenderness at base of skull pain is neuralgic in character and referred to vertex or forehead Usually worse when lying down nasal congestion tenderness over affected sinus Neurologic abnormalities, confusion, altered mental status or level of consciousness Uncommon sudden onset duration of minutes to hours repeats over a course of weeks, then may disappear for months or years unilateral lacrimation and nasal congestion severe unilateral and periorbital pain more common in men patient is restless during episode Worse with neck movement posterior distribution pain is neuralgic in character and sometimes referred to vertex or forehead more common in older patients May be insidious or associated with dyspnea occurs more commonly in colder monthsĬause of stroke can be spontaneous or follow minor trauma or sudden neck movement unilateral headache or face pain ipsilateral Horner syndrome Often abrupt onset associated with nausea, vomiting, dizziness, blurred vision, and papilledema may have cranial nerve V1 palsy aggravated by coughing, straining, or changing position Marked blood pressure elevation (systolic > 210 mm Hg or diastolic > 120 mm Hg) may have confusion or irritabilityīenign intracranial hypertension (pseudotumor cerebri) History of at least 2 attacks fulfilling above criteriaĪssociated with blurred vision, nausea, vomiting, and seeing halos around lights ophthalmologic emergencyĪntecedent trauma may have subacute onset altered level of consciousness or neurologic deficit may be present Headache fulfilling criteria for migraine without aura begins during the aura or follows aura within 60 minutes Homonymous visual symptoms and/or unilateral sensory symptomsĪt least 1 aura symptom develops gradually over 5 minutes, or different aura symptoms occur in succession over 5 minutesĮach symptom lasts at least 5 minutes, but no longer than 60 minutes Visual symptoms that are fully reversible, including positive features (e.g., flickering lights, spots, lines) and/or negative features (e.g., loss of vision) Sensory symptoms that are fully reversible, including positive features (e.g., pins and needles) and/or negative features (e.g., numbness) History of at least 5 attacks fulfilling above criteriaĪura consisting of at least 1 of the following, but no motor weakness:įully reversible dysphasic speech disturbance Headache has at least 2 of the following:Īggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs)ĭuring headache, at least 1 of the following: Headache lasts 4 to 72 hours (untreated or unsuccessfully treated) Several treatment principles, including taking medication early in an attack and using a stratified treatment approach, can help ensure that migraine treatment is cost-effective. The pharmacologic properties, potential adverse effects, cost, and routes of administration vary widely, allowing therapy to be individualized based on the pattern and severity of attacks. Other medications such as dihydroergotamine and antiemetics are recommended for use as second- or third-line therapy for select patients or for those with refractory migraine. Although triptans are effective, they may be expensive. Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines. Acetaminophen, nonsteroidal anti-inflammatory drugs, triptans, antiemetics, ergot alkaloids, and combination analgesics have evidence supporting their effectiveness in the treatment of migraine. Migraine is a primary headache disorder characterized by recurrent attacks.
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