{ "schemaVersion": 2, "eyebrow": "Neurology", "title": "Migraine Headache", "summary": "Diagnose migraine clinically while screening for secondary headache and medication overuse; treat attacks early, select prevention by monthly migraine burden and comorbidity, and use parenteral evidence-based regimens for refractory emergency presentations.", "seoDescription": "Point-of-care migraine diagnosis and management: imaging triage, medication-overuse thresholds, acute therapy, prevention, and emergency treatment.", "clinicalQuestion": "How should physicians evaluate, acutely treat, prevent, and monitor migraine while avoiding missed secondary headache and medication overuse?", "specialty": "Neurology", "audience": "U.S. physicians and medical trainees", "tags": [ "migraine", "acute migraine treatment", "migraine prevention", "medication-overuse headache", "migraine neuroimaging", "emergency department migraine" ], "keyTakeaways": [ "Do not obtain routine neuroimaging for typical migraine without aura when the neurologic examination is normal and no red-flag or atypical features are present; focus on symptom treatment and reassurance. [21]", "Actively identify medication-overuse headache when headache develops or worsens during at least 3 months of acute-drug use: triptans, opioids, ergots, or combination analgesics on 10 or more days per month, or simple analgesics/NSAIDs on 15 or more days per month. [20][23][24]", "Initiate preventive therapy at 4 or more migraine days per month, or at 2 or more migraine days per month when attacks are disabling despite acute treatment. [7]", "For adults requiring parenteral emergency treatment, offer IV prochlorperazine or greater occipital nerve block when eligible; do not offer IV hydromorphone. [11]" ], "sections": [ { "id": "initial-triage", "eyebrow": "First decision", "heading": "Separate typical migraine from secondary headache before treating", "intro": "Use the headache phenotype, neurologic examination, temporal pattern, and red flags to determine whether urgent testing supersedes migraine-directed therapy.", "paragraphs": [ "A patient with established, typical migraine, a normal neurologic examination, and no red-flag or atypical features generally does not need brain imaging. The American College of Radiology and American Headache Society recommend against routine neuroimaging in this setting; estimated tumor yield in a patient without malignancy history and uncomplicated headache is less than 0.1%. [21]", "Escalate beyond a primary-migraine pathway for abrupt or progressive change in headache pattern, abnormal neurologic findings, systemic illness, immunocompromise, cancer history, pregnancy-related concern, trauma, positional headache, papilledema, or features suggesting vascular disease, infection, inflammation, mass lesion, or abnormal intracranial pressure. Medication overuse is itself a common secondary headache cause and should be assessed at every acute-care and preventive-treatment visit. [21]", "For suspected idiopathic intracranial hypertension, obtain neuroimaging before lumbar puncture to exclude a space-occupying lesion and evaluate secondary causes; a cerebrospinal fluid opening pressure of at least 25 cm H2O is a diagnostic criterion. [21]" ], "bullets": [ "Investigate or refer for atypical aura with motor weakness, diplopia, monocular visual symptoms, poor balance, or decreased consciousness rather than presuming typical migraine aura. [23]", "Use a headache diary to document attack frequency, duration, severity, acute-medication days, menstrual timing, and treatment response; diary data determine both medication-overuse risk and prevention eligibility. [17][23]" ], "subsections": [], "table": { "caption": "Features that redirect a presumed migraine presentation toward secondary-headache evaluation. [21][23]", "columns": [ "Presentation feature", "Interpretation", "Next action" ], "rows": [ [ "Typical recurrent migraine; normal examination; no red flags", "Low likelihood of clinically important intracranial pathology. [21]", "Do not order routine neuroimaging; treat the attack and establish a longitudinal plan. [21]" ], [ "New or changed pattern, focal examination finding, systemic or vascular concern, papilledema, positional phenotype, cancer or immunocompromise", "Secondary headache must be considered. [21]", "Select urgent neuroimaging and directed evaluation based on the suspected process. [21]" ], [ "Motor aura, diplopia, monocular visual symptoms, poor balance, or decreased consciousness", "Atypical aura features warrant further investigation or referral. [23]", "Do not manage as uncomplicated typical aura without further assessment. [23]" ], [ "Headache worsened during frequent acute-medication use for at least 3 months", "Medication-overuse headache is likely contributing. [20][23][24]", "Count medication-specific use days and institute an acute-medication reduction plan with preventive treatment when indicated. [7][20][23]" ] ] } }, { "id": "clinical-diagnosis", "eyebrow": "Phenotype", "heading": "Confirm the migraine phenotype and identify modifiers that change management", "intro": "The clinical history should establish migraine subtype, attack burden, and acute-treatment constraints.", "paragraphs": [ "Migraine is diagnosed primarily from history. In adults, attacks typically last 4 to 72 hours and are accompanied by nausea, vomiting, photophobia, and/or phonophobia; aura may produce reversible visual, sensory, or speech symptoms. [15][23] In children and adolescents, attacks may last 2 to 72 hours, are often bilateral, and may have prominent gastrointestinal symptoms. [5]", "Document whether aura is typical versus atypical. Typical aura may be visual positive or negative phenomena, sensory positive or negative symptoms, or speech disturbance; atypical symptoms should shift management toward investigation rather than routine migraine escalation. [23]", "Identify menstrual association with a diary spanning at least two cycles. Suspect menstrual-related migraine when attacks occur predominantly from 2 days before through 3 days after menstruation begins in at least 2 of 3 consecutive cycles. [23] This pattern permits consideration of short-term perimenstrual prevention with frovatriptan, naratriptan, or zolmitriptan started several days before the anticipated menstrual onset and continued for 5 to 6 days. [17]" ], "bullets": [ "Ask specifically about depression, epilepsy, stroke, and myocardial infarction because these comorbidities occur with migraine and may affect treatment selection or safety assessment. [10]", "In apparent late-onset migraine, suspect an underlying cause; older adults also have higher risks of secondary headache, comorbidity, and treatment adverse effects. [5]" ], "subsections": [], "table": { "caption": "Clinical patterns with immediate management implications. [5][17][23]", "columns": [ "Pattern", "How to establish it", "Management implication" ], "rows": [ [ "Typical aura", "Reversible visual, sensory, or speech symptoms. [23]", "Manage as migraine after confirming no atypical aura feature. [23]" ], [ "Atypical aura", "Motor weakness, diplopia, monocular visual symptoms, poor balance, or decreased consciousness. [23]", "Pursue further investigation and/or referral. [23]" ], [ "Menstrual-related migraine", "Diary shows attacks from day -2 through day +3 of menses in at least 2 of 3 cycles; document at least 2 cycles. [23]", "Consider short-term perimenstrual triptan prevention for 5 to 6 days around expected onset. [17]" ], [ "Pediatric migraine", "History-based diagnosis; attacks can last 2 to 72 hours and may be bilateral with gastrointestinal prominence. [5]", "Use age-appropriate acute and preventive strategies; ibuprofen is recommended for acute treatment when bed rest is insufficient. [5]" ] ] } }, { "id": "acute-outpatient-treatment", "eyebrow": "Attack treatment", "heading": "Treat attacks early and match therapy to attack severity and contraindications", "intro": "Set an attack plan that treats early, limits acute-medication days, and specifies escalation when oral therapy fails.", "paragraphs": [ "For mild migraine attacks, use an analgesic or NSAID early in the attack; for moderate or severe attacks, use a triptan when there is no contraindication. [10] Acute migraine therapies should be selected with cardiovascular safety, prior efficacy, and tolerability in mind; vascular safety concerns are a key limitation of triptans and other vasoconstrictive therapies. [10]", "Avoid opioids as first-line treatment for acute migraine. Guidelines recommend against opioid-first approaches for migraine and other primary headaches, and the 2025 American Headache Society emergency evidence assessment states that IV hydromorphone must not be offered to eligible adults presenting with migraine requiring parenteral therapy. [9][11]", "For pregnancy, offer paracetamol for acute migraine. A triptan or NSAID may be considered only after discussing the treatment need and risks. [23] For children and adolescents, bed rest may suffice for some attacks; otherwise, ibuprofen is recommended for acute treatment. [5]" ], "bullets": [ "Review every acute medication, including over-the-counter combination products, at each follow-up visit; do not allow triptans, opioids, ergots, or combination analgesics to reach 10 or more days per month for 3 months, or simple analgesics/NSAIDs to reach 15 or more days per month for 3 months. [20][23][24]", "If acute treatment repeatedly fails, confirm the diagnosis, reassess medication overuse and red flags, review timing of treatment, and initiate or optimize prevention when the patient meets burden criteria. [7][21]" ], "subsections": [], "table": { "caption": "Acute-treatment selection by clinical setting. [5][9][10][11][23]", "columns": [ "Setting or scenario", "Preferred approach", "Avoid or escalate" ], "rows": [ [ "Mild outpatient attack", "Use an analgesic or NSAID early in the attack. [10]", "Track use days to prevent medication-overuse headache. [20][23]" ], [ "Moderate or severe outpatient attack", "Use a triptan when appropriate and not contraindicated. [10]", "Reassess cardiovascular safety and treatment response. [10]" ], [ "Pregnancy", "Offer paracetamol; consider a triptan or NSAID only after risk-benefit discussion. [23]", "Avoid automatic extrapolation of nonpregnant regimens. [23]" ], [ "Child or adolescent", "Bed rest may suffice; otherwise use ibuprofen. [5]", "Reassess phenotype and secondary-headache features when presentation is atypical. [5][21]" ], [ "Parenteral emergency treatment needed", "Offer IV prochlorperazine or greater occipital nerve block to eligible adults without contraindications. [11]", "Do not offer IV hydromorphone. [11]" ] ] } }, { "id": "emergency-department-management", "eyebrow": "Refractory attack", "heading": "Use evidence-based parenteral therapy for emergency presentations", "intro": "After excluding a time-sensitive secondary cause, use nonopioid parenteral treatment and nerve-block options according to eligibility.", "paragraphs": [ "For adults in the emergency department with migraine requiring parenteral therapy, IV prochlorperazine and greater occipital nerve block should be offered when no contraindication is present. Ketorolac IV, metoclopramide IV, subcutaneous sumatriptan, and supraorbital nerve block should be offered when appropriate. [11]", "Chlorpromazine IV, dexamethasone IV, and valproate IV may be offered, reflecting lower-certainty support than the therapies that should or must be offered. IV paracetamol should not be offered for this indication. [11] Treatment failure should prompt reassessment for diagnostic error, medication overuse, and a secondary headache process rather than opioid rescue. [11][21]" ], "bullets": [ "Consider eptinezumab only for patients matching its clinical-trial population; no recommendation was made for an ED-specific population. [11]", "If a nerve block is selected, document the headache phenotype, prior treatment response, and post-procedure response to guide future rescue planning. [11]" ], "subsections": [], "table": { "caption": "American Headache Society 2025 recommendations for adults with migraine requiring parenteral emergency treatment. [11]", "columns": [ "Recommendation level", "Intervention", "Clinical use" ], "rows": [ [ "Must offer", "IV prochlorperazine; greater occipital nerve block. [11]", "Offer to eligible adults without contraindications. [11]" ], [ "Should offer when appropriate", "IV dexketoprofen, IV ketorolac, IV metoclopramide, subcutaneous sumatriptan, supraorbital nerve block. [11]", "Use according to contraindications and prior treatment exposure. [11]" ], [ "May offer", "IV chlorpromazine, IV dexamethasone, IV valproate. [11]", "Consider when higher-recommendation options are unsuitable or insufficient. [11]" ], [ "Must not offer", "IV hydromorphone. [11]", "Do not use as parenteral migraine treatment. [11]" ], [ "Should not offer", "IV paracetamol. [11]", "Select another evidence-supported parenteral option. [11]" ] ] } }, { "id": "preventive-treatment", "eyebrow": "Longitudinal control", "heading": "Start prevention based on migraine-day burden and individualize the regimen", "intro": "Prevention reduces attack frequency, severity, duration, distress, and disability when acute therapy alone is insufficient.", "paragraphs": [ "Initiate preventive treatment when a patient has 4 or more migraine days per month, or 2 or more migraine days per month with disabling attacks despite acute treatment. [7] Before selecting an agent, quantify monthly migraine days, acute-medication days, disability, prior preventive trials, pregnancy potential, blood pressure and cardiovascular history, psychiatric comorbidity, epilepsy, and treatment preference.", "Medication options for episodic migraine prevention include angiotensin-receptor blockers, lisinopril, magnesium, topiramate, valproate, and memantine. [4] In children and adolescents, propranolol, amitriptyline, or topiramate are prevention options. [5] Use the headache diary to assess baseline burden and response rather than judging efficacy from recollection alone. [17]", "CGRP-targeting options include oral atogepant, IV eptinezumab, and subcutaneous fremanezumab, erenumab, and galcanezumab. [12] For episodic migraine, rimegepant is an oral CGRP inhibitor option for adults with 4 to fewer than 15 migraine attacks per month in the cited guidance after at least 3 preventive medicines have failed, are not tolerated, or are unsuitable; this access framework is not a U.S. coverage standard. [12]", "For menstrual-predominant attacks, a short-term triptan strategy can supplement or replace continuous prevention when the diary demonstrates predictable timing: start frovatriptan, naratriptan, or zolmitriptan several days before expected menses and continue for 5 to 6 days. [17]" ], "bullets": [ "Set a diary-based follow-up target that includes monthly migraine days, acute-medication days, disability, adverse effects, and persistence with treatment. [17][18]", "If headache frequency rises despite prevention, first reassess acute-medication exposure because triptan, opioid, ergot, combination-analgesic, and simple-analgesic thresholds identify medication overuse that can perpetuate headache. [20][23][24]", "Use nonpharmacologic adjuncts when acceptable, including trigger identification with a diary, relaxation, cognitive behavioral therapy, biofeedback, acupuncture, or massage; these should complement rather than obscure assessment of pharmacologic response. [17]" ], "subsections": [], "table": { "caption": "Preventive-treatment pathways organized by burden and phenotype. [4][5][7][12][17]", "columns": [ "Clinical situation", "Prevention strategy", "Monitoring decision" ], "rows": [ [ "At least 4 migraine days per month", "Initiate preventive therapy; options include topiramate, valproate, angiotensin-receptor blockers, lisinopril, magnesium, or memantine. [4][7]", "Use a headache diary to track migraine days, disability, adverse effects, and acute-medication days. [17]" ], [ "At least 2 migraine days per month with disabling attacks despite acute treatment", "Initiate prevention rather than repeatedly escalating acute therapy. [7]", "Check for medication-overuse thresholds at each reassessment. [20][23]" ], [ "Pediatric or adolescent migraine requiring prevention", "Consider propranolol, amitriptyline, or topiramate. [5]", "Track frequency and functional impact with a diary. [17]" ], [ "Predictable menstrual-related migraine", "Use short-term frovatriptan, naratriptan, or zolmitriptan beginning several days before menses for 5 to 6 days. [17]", "Confirm timing over at least 2 diary-recorded cycles. [23]" ], [ "Prior preventive failures or intolerance", "Consider CGRP-targeting prevention, including atogepant, eptinezumab, fremanezumab, erenumab, galcanezumab, or rimegepant where clinically appropriate and accessible. [12]", "Document prior preventive exposure, benefit, tolerability, and access requirements. [12]" ] ] } }, { "id": "medication-overuse-and-follow-up", "eyebrow": "Prevent chronicity", "heading": "Treat medication overuse as a diagnostic and therapeutic priority", "intro": "Frequent acute-drug exposure can worsen headache and make both acute and preventive regimens appear ineffective.", "paragraphs": [ "Diagnose suspected medication-overuse headache from the pattern of worsening or newly developed headache during frequent acute-medication use for 3 months or more. The exposure threshold is 10 or more days per month for triptans, opioids, ergots, and combination analgesics, and 15 or more days per month for acetaminophen, aspirin, or NSAIDs. [20][23][24]", "The practical response is to reconcile all prescribed and over-the-counter acute agents, identify the specific overused class, reduce or eliminate the overused medication, and establish preventive treatment when attack burden meets criteria. [7][20][23] Continue diary tracking because a falling acute-medication-day count is as clinically important as a reduction in headache days.", "At follow-up, re-evaluate any apparent treatment failure for a changed phenotype, atypical aura, new red flags, and medication overuse before simply adding rescue drugs. This is especially important in late-onset presentations and in older adults, in whom secondary headache and medication adverse effects are more consequential. [5][21]" ], "bullets": [ "Count days of use, not tablet count, when screening for medication overuse. [20][23][24]", "Do not substitute opioid rescue for recurrent treatment failure; IV hydromorphone is specifically not recommended for parenteral emergency migraine treatment. [11]", "Reassess treatment satisfaction and adherence alongside frequency, severity, duration, and disability because preventive goals extend beyond headache-day reduction. [6]" ], "subsections": [], "table": { "caption": "Medication-overuse thresholds requiring intervention when exposure persists for at least 3 months. [20][23][24]", "columns": [ "Acute medication class", "Threshold", "Action" ], "rows": [ [ "Triptans, opioids, ergots, or combination analgesics", "10 or more days per month. [20][23][24]", "Identify medication-overuse headache, reduce or eliminate overused therapy, and reassess prevention. [7][20][23]" ], [ "Acetaminophen, aspirin, or NSAIDs", "15 or more days per month. [20][23][24]", "Identify medication-overuse headache, reduce or eliminate overused therapy, and reassess prevention. [7][20][23]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Acute Treatments for Episodic Migraine in Adults", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/2781052", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 2, "title": "Preventive Medications in Pediatric Migraine", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2824677", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 3, "title": "Advances in migraine prevention", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00477-6/abstract", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 4, "title": "clinical guideline", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/pdf/10.7326/ANNALS-24-00551", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 5, "title": "Diagnosis and management of migraine in ten steps", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41582-021-00509-5", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 6, "title": "Migraine | Annals of Internal Medicine", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/AITC202301170", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 7, "title": "2023 U.S. Department of Veterans Affairs and ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/ANNALS-24-00551", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 8, "title": "A Systematic Review and Network Meta-analysis for the ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/ANNALS-24-00315", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 9, "title": "Characteristics of Patients Referred To A Specialized Headache Clinic | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-020-58234-w", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 10, "title": "Migraine | Nature Reviews Disease Primers", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41572-021-00328-4", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 11, "title": "2025 guideline update to acute treatment of migraine for adults in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies - 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CKS - NICE", "detail": "cks.nice.org.uk", "url": "https://cks.nice.org.uk/topics/migraine/management/adults", "authors": "cks.nice.org.uk", "host": "cks.nice.org.uk" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Acute Treatments for Episodic Migraine in Adults", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/2781052", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by JH VanderPluym · 2021 · Cited by 212 — This systematic review and meta-analysis assesses the benefits and harms associated with acute treatments for episodic migraine,", "score": 0.42048118 }, { "number": 2, "title": "Preventive Medications in Pediatric Migraine", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2824677", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by O Kohandel Gargari · 2024 · Cited by 29 — This meta-analysis evaluates the efficacy and safety associated with various pharmacological treatments for pediatric migraine.", "score": 0.402745 }, { "number": 3, "title": "Advances in migraine prevention", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00477-6/abstract", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "by D Martinelli · 2026 · Cited by 3 — American Headache Society Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine:", "score": 0.36983892 }, { "number": 4, "title": "clinical guideline", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/pdf/10.7326/ANNALS-24-00551", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "by JJ Sico · 2024 · Cited by 18 — Medications to prevent episodic migraine (EM) include angiotensin-receptor blockers, lisinopril, magnesium, topiramate, valproate, memantine,.", "score": 0.60498303 }, { "number": 5, "title": "Diagnosis and management of migraine in ten steps", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41582-021-00509-5", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. ", "score": 0.57780564 }, { "number": 6, "title": "Migraine | Annals of Internal Medicine", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/AITC202301170", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "According to the American Headache Society, the goals of preventive treatment are to reduce attack frequency, severity, duration, distress, and", "score": 0.5264164 }, { "number": 7, "title": "2023 U.S. Department of Veterans Affairs and ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/ANNALS-24-00551", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "by JJ Sico · 2024 · Cited by 18 — Preventive migraine therapies should be initiated when patients have 4 or more migraine days per month or when they have 2 or more migraine days", "score": 0.4921643 }, { "number": 8, "title": "A Systematic Review and Network Meta-analysis for the ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/ANNALS-24-00315", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "by JAA Damen · 2025 · Cited by 17 — This review informs a clinical practice guideline on the prevention of episodic migraine for the American College of Physicians (ACP).", "score": 0.428784 }, { "number": 9, "title": "Characteristics of Patients Referred To A Specialized Headache Clinic | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-020-58234-w", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Table 1 Baseline data, brain imaging and emergency observations in the study populations.\n\nFull size table\n\nMigraine was diagnosed in 84 patients (mean age 46.1 ± 14.7 years) corresponding to the IHS criteria (66 females, mean age 47.12 ± 15.3 years and 18 males, mean age 42.22 ± 11.3 years). All pa", "score": 0.3320293 }, { "number": 10, "title": "Migraine | Nature Reviews Disease Primers", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41572-021-00328-4", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Migraine is a common, chronic, disorder that is typically characterized by recurrent disabling attacks of headache and accompanying symptoms, including aura. The aetiology is multifactorial with rare monogenic variants. Depression, epilepsy, stroke and myocardial infarction are comorbid diseases. Sp", "score": 0.32450345 }, { "number": 11, "title": "2025 guideline update to acute treatment of migraine for adults in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies - PubMed", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/41321235", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "Methods: We conducted a systematic review and meta-analysis using the same methodology as the 2016 guideline. The original search strategy was repeated and expanded to include studies of nerve blocks and sphenopalatine ganglion (SPG) blocks. We searched Medline, Embase, Cochrane, clinicaltrials.gov,", "score": 0.6680367 }, { "number": 12, "title": "Headaches in over 12s: diagnosis and management - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK553317", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "NICE Clinical Guidelines, No. 150\n\nThis guideline is the basis of QS42.\n\nThis guideline should be read in conjunction with NG193.\n\n## Overview\n\nThis guideline covers the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster", "score": 0.66308063 }, { "number": 13, "title": "State of the art in the management of migraine—A response to the American College of Physicians migraine preventive treatment guideline", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12497935", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "listed on the AHS website. The American Headache Society is a nonprofit organization that receives support from industry for educational programming, research, and advocacy. This includes support from multiple companies that are involved in the development, distribution, and marketing of therapies t", "score": 0.5117904 }, { "number": 14, "title": "The American Headache Society Consensus Statement", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/34160823", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "by J Ailani · 2021 · Cited by 719 — The American Headache Society previously published a Consensus Statement on the use of newly introduced treatments for adults with migraine. This update", "score": 0.42763633 }, { "number": 15, "title": "Migraine and other headache disorders", "detail": "www.who.int", "url": "https://www.who.int/news-room/fact-sheets/detail/headache-disorders", "authors": "www.who.int", "host": "www.who.int", "snippet": "Many of those troubled by headaches do not receive effective diagnosis and care. Appropriate treatment of headache disorders requires training of health professionals, accurate diagnosis and recognition of the conditions, appropriate treatment with cost-effective medications, simple lifestyle modifi", "score": 0.42634606 }, { "number": 16, "title": "The American Headache Society Position Statement On ...", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/30536394", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "by AH Society · 2019 · Cited by 368 — Methods: This statement is based on a review of existing guidelines and principles for preventive and acute treatment of migraine, as well as", "score": 0.42190963 }, { "number": 17, "title": "Migraine Prophylaxis - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK507873", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "2. Non-pharmacological Therapies\n\nIdentifying and modifying the trigger, if possible, is important. It is helpful to maintain headache diaries to identify triggers and follow responses when triggers become modified. Therapies that can help prevent migraines include relaxation, acupuncture, massage, ", "score": 0.38901308 }, { "number": 18, "title": "Migraine Headache - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK560787", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Diagnosis involves patient history, physical examination, and meeting specific diagnostic criteria. Management strategies encompass acute treatments for immediate relief during attacks, preventive therapies to reduce frequency and severity, and personalized lifestyle adjustments. This activity revie", "score": 0.38783002 }, { "number": 19, "title": "Prevalence and burden of migraine in the United States", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/38700185", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "by F Cohen · 2024 · Cited by 111 — This study reviewed migraine prevalence and disability gathered through epidemiologic survey studies in the United States conducted over the past three decades.", "score": 0.20750399 }, { "number": 20, "title": "Assessment report - Vyepti - European Medicines Agency", "detail": "www.ema.europa.eu", "url": "https://www.ema.europa.eu/en/documents/assessment-report/vyepti-epar-public-assessment-report_en.pdf", "authors": "www.ema.europa.eu", "host": "www.ema.europa.eu", "snippet": "with 4 to 14 MHDs/month at baseline) and ALD403-CLIN-011 (Chronic Migraine, recruiting patients with ≥15 to ≤26 headache days of which at least 8 with features of migraine ). Up to six (Study 011) and 12 months (Study 006) of placebo-controlled data are available from the 2 pivotal studies. Key incl", "score": 0.55391616 }, { "number": 21, "title": "When is brain MRI with and without contrast indicated for evaluation of headache? | Cleveland Clinic Journal of medicine", "detail": "www.ccjm.org", "url": "https://www.ccjm.org/content/93/8/463", "authors": "www.ccjm.org", "host": "www.ccjm.org", "snippet": "Headache is a commonly encountered patient concern in a variety of clinical settings, and clinicians are tasked with differentiating primary headaches (ie, migraine, tension-type headache, and trigeminal autonomic cephalgias) from secondary headaches to determine when imaging is needed, and further,", "score": 0.52510154 }, { "number": 22, "title": "Headache and Facial Pain: Differential Diagnosis and ...", "detail": "www.jaci-inpractice.org", "url": "https://www.jaci-inpractice.org/article/S2213-2198(13)00148-7/abstract", "authors": "www.jaci-inpractice.org", "host": "www.jaci-inpractice.org", "snippet": "by JA Bernstein · 2013 · Cited by 31 — Primary headache disorders include migraine without and with aura, Red flags in patients presenting with headache: clinical indications for neuroimaging Br J", "score": 0.5236402 }, { "number": 23, "title": "Headaches in over 12s: diagnosis and management", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/cg150/chapter/recommendations", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "double vision or\n\nvisual symptoms affecting only 1 eye or\n\npoor balance or\n\ndecreased level of consciousness. \n\n#### Menstrual‑related migraine\n\n##### 1.2.5\n\nSuspect menstrual‑related migraine if migraine occurs predominantly between 2 days before and 3 days after the start of menstruation in at lea", "score": 0.493336 }, { "number": 24, "title": "Scenario: Adults | Management | Migraine - CKS - NICE", "detail": "cks.nice.org.uk", "url": "https://cks.nice.org.uk/topics/migraine/management/adults", "authors": "cks.nice.org.uk", "host": "cks.nice.org.uk", "snippet": "Medication overuse headache (MOH) MOH can occur with 15 or more days per month use of simple analgesics … or 10 or more days use per month of triptans", "score": 0.38193452 } ], "publishedAt": "2026-08-24T16:19:15.529606+00:00", "updatedAt": "2026-08-24T16:19:15.529606+00:00", "readingMinutes": 6, "slug": "migraine-headache" }