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