What is Migraine?
Migraine is a primary neurological disorder characterized by recurrent episodes of moderate to severe unilateral (or occasionally bilateral) headache, typically pulsating in quality, lasting 4–72 hours, and associated with nausea, vomiting, photophobia, and phonophobia. It is the second most common cause of disability worldwide.
Approximately 25–30% of migraine patients experience aura — transient, fully reversible neurological symptoms (typically visual, sensory, or speech-related) that precede or accompany the headache phase. In "migraine aura without headache," neurological symptoms occur without the headache phase.
Headache Classification Committee of the International Headache Society. ICHD-3. Cephalalgia. 2018;38(1):1–211. doi:10.1177/0333102417738202 — Authoritative classification and diagnostic criteria for migraine.
Diagnosis
ICHD-3 criteria for migraine without aura require: ≥5 attacks lasting 4–72 hours with at least 2 of the following headache features (unilateral, pulsating, moderate/severe, worsened by activity) AND at least 1 of: nausea/vomiting, or photophobia and phonophobia.
Treatment
- Acute: triptans (first-line), NSAIDs, antiemetics, CGRP antagonists (gepants)
- Preventive: beta-blockers (propranolol), topiramate, amitriptyline, anti-CGRP monoclonal antibodies (erenumab, fremanezumab)
- Lifestyle: sleep hygiene, hydration, stress management, trigger avoidance
|
🔴 RED FLAGS — Seek Emergency Care Immediately • "First or worst" headache — requires exclusion of SAH • Headache with fever and neck stiffness — meningitis • New aura in patient >50 years — exclude TIA/stroke • Progressive headache — exclude space-occupying lesion • Headache with papilloedema — exclude raised ICP |