Migraine headache
Definition
Migraine Headache without Aura
- At least 5 attacks of headache fulfilling the following criteria:
- 1.HA attacks lasting 4–72 hr (untreated or unsuccessfully treated) (>1 h for children)
- 2.HA has at least 2 of the following characteristics:
- a.Unilateral location
- b.Pulsating quality
- c.Moderate or severe pain intensity
- d.Aggravation by or causing avoidance of routine physical activity
- 3.During HA at least one of the following occurs:
- a.Nausea and/or vomiting
- b.Photophobia and phonophobia (may be inferred from behavior)
- 4.Not attributed to another disorder
Migraine Likelihood
- If pt has at least 4 of the following 5 "POUNDing" features LR of migraine is 24
- Pulsatile quality
- duration of 4-72 hOurs
- Unilateral
- Nausea or vomiting
- Disabling in quality
Treatment
- Migraine
- 1st line: Prochlorperazine (compazine) 10mg IV (+/- benadryl)
- Most effective therapy
- 2nd line:
- Metoclopramide (reglan) 10mg IV
- DHE 1mg IV (often used with an antiemetic)
- Contraindications: pregnancy, cardiovascular disease, HTN
- Triptans
- Contraindications: cardiovascular disease, use of DHE in previous 24hrs
- Ketorolac
- 1st line: Prochlorperazine (compazine) 10mg IV (+/- benadryl)
See Also
Source
- International Headache Society Diagnostic Criteria
- Detsky et. al, JAMA '06 Does this Patient with a Headache have a Migraine or need Neuroimaging?