Mount Carmel Health Partners Clinical Guidelines Migraine

Migraine Clinical Guideline Definition: Migraine refers to a chronic neurological disorder characterized by episodic attacks often in association with en- hanced sensitivity of the nervous system and activation of the trigeminal-vascular system. A diagnosis of migraine requires sec- ondary headache causes be ruled out as it is classified as a primary headache and is not associated with other diseases. Management of Acute Migraine Headache Patient presents with symptoms suggestive of migraine headache; screen for red flags (see Table B) Evaluation Treatment Obtain detailed history and perform complete physical with neurological examination Evaluate for meningitis or subarachnoid hemorrhage Yes Are there symptoms of fever, neck stiffness, or abrupt onset of severe headache? No Consider neuroimaging Quick Guide to Migraine A headache, usually unilateral but occasionally bilateral, with pulsating pain of moderate to severe intensity, often accompanied by photophobia, phonophobia, and/or nausea and vomiting; may occur with or without prodrome and aura. Migraine headaches can exhibit a recurrent pattern and can significantly affect activities of daily living. Migraine prevalence varies by age, sex, and ethnicity with the highest prevalence in whites, followed by African Americans, and then Asians. 75% of migraine sufferers are women. Are there reasons to perform neuroimaging: • focal neurologic signs or symptoms? • onset of symptoms with exertion, cough, or sexual activity? • onset of headache after age 50? • recent significant change in pattern, frequency, or severity? • progressive worsening despite appropriate therapy? • headache that does not fit a strict definition of migraine? Yes No See treatment algorithm (see next page) Yes Are there characteristics of a migraine: • acute onset? • prodrome symptoms of euphoria, irritability, or food craving? • aura of visual, auditory, somatosensory, or motor symptoms? • unilateral location mostly? • throbbing or pulsatile quality? • nausea or vomiting? • gradual and progressive character? • photophobia and phonophobia? No Evaluate for other causes of headache (see Table A) October 2017