Migraine headache

Revision as of 14:14, 22 March 2016 by Ostermayer (talk | contribs) (Text replacement - "Category:Neuro" to "Category:Neurology")


Definition: Migraine Headache without Aura[1]

  • At least 5 attacks of headache fulfilling the following criteria:
    • HA attacks lasting 4–72 hr (untreated or unsuccessfully treated) (>1 h for children)
    • HA has at least 2 of the following characteristics:
      • Unilateral location
      • Pulsating quality
      • Moderate or severe pain intensity
      • Aggravation by or causing avoidance of routine physical activity
    • During HA at least one of the following occurs:
      • Nausea and/or vomiting
      • Photophobia and phonophobia (may be inferred from behavior)
    • Not attributed to another disorder

Clinical Features

If at least 4 of the following "POUNDing" features, LR of migraine is 24[2]

  • Pulsatile quality
  • Onset/duration of 4-72 hours
  • Unilateral
  • Nausea or vomiting
  • Disabling in quality

Differential Diagnosis






Aseptic Meningitis


  • Consider other causes of emergent headache
  • Diagnosis is normally clinical


See Also


  1. International Headache Society Diagnostic Criteria
  2. Detsky et. al, JAMA '06 Does this Patient with a Headache have a Migraine or need Neuroimaging?
  3. Coppola et al, Annals of Emergency Medicine, Nov 1995. Randomized, Placebo-Controlled Evaluation of Prochlorperazine Versus Metoclopramide for Emergency Department Treatment of Migraine Headaches.