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 one aura symptom develops gradually over five minutes or different aura symptoms occur in succession over five minutesĮach symptom lasts at least five minutes, but no longer than 60 minutes Visual symptoms that are fully reversible, including positive features (flickering lights, spots, lines) and/or negative features (loss of vision) Sensory symptoms that are fully reversible, including positive features (pins and needles) and/or negative features (numbness) Less commonly, headache lacks migrainous features or is completely absentĪura consisting of at least one of the following, but no motor weakness:įully reversible dysphasic speech disturbance Headache with the features of migraine without aura usually follows the aura symptoms Recurrent disorder manifesting in headaches of reversible focal neurologic symptoms that usually develop gradually over five to 20 minutes and last for less than 60 minutes History of at least five attacks fulfilling above criteria Headache has at least two of the following:Īggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs)ĭuring headache, at least one of the following: Headache lasts four to 72 hours (untreated or unsuccessfully treated) Acetaminophen, ibuprofen, intranasal sumatriptan, and intranasal zolmitriptan seem to be effective in children and adolescents, although data in these age groups are limited. During pregnancy, migraine may be treated with acetaminophen or nonsteroidal anti-inflammatory drugs (prior to third trimester), or opiates in refractory cases. Medications containing opiates or barbiturates should be avoided for acute migraine. Isometheptene-containing compounds and intranasal dihydroergotamine are also reasonable therapeutic options. Intranasal lidocaine may also have a role in relief of acute migraine. Dexamethasone may be a useful adjunct to standard therapy in preventing short-term headache recurrence. Intravenous antiemetics, with or without intravenous dihydroergotamine, are effective therapies in an emergency department setting. Triptans should be avoided in patients with vascular disease, uncontrolled hypertension, or hemiplegic migraine. Triptans are first-line therapies for moderate to severe migraine, or mild to moderate migraine that has not responded to adequate doses of simple analgesics. Effective first-line therapies for mild to moderate migraine are nonprescription nonsteroidal anti-inflammatory drugs and combination analgesics containing acetaminophen, aspirin, and caffeine. Abortive therapy should be used as early as possible after the onset of symptoms. Data comparing different drug classes are relatively scarce. Treating acute migraine is challenging because of substantial rates of nonresponse to medications and difficulty in predicting individual response to a specific agent or dose. Before diagnosing migraine, serious intracranial pathology must be ruled out. 6, 2021.Migraine headache is a common and potentially debilitating disorder often treated by family physicians. Preventive treatment of episodic migraine in adults. National Institute of Neurological Disorders and Stroke. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. Clinical neurophysiology of migraine with aura.
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