Recurrent primary headache disorder with moderate-severe unilateral throbbing pain, nausea and sensory sensitivity, with or without aura.
Clinical features
- • Unilateral pulsating headache 4–72 h
- • Photophobia, phonophobia
- • Nausea/vomiting
- • Visual aura (fortification spectra) in 25%
Investigations
- • Clinical diagnosis (ICHD-3)
- • Neuroimaging only if red flags — thunderclap, focal deficit, new headache >50 y, immunosuppression
Differential diagnosis
- • Tension-type headache
- • Cluster headache
- • Medication-overuse headache
- • SAH
- • Idiopathic intracranial hypertension
Management
- • Acute: aspirin 900 mg or naproxen 500 mg + antiemetic
- • Triptan (sumatriptan 50–100 mg) if NSAID inadequate
- • Prophylaxis if ≥4 headache days/month: propranolol, topiramate, amitriptyline, candesartan
- • CGRP monoclonal antibody if ≥3 preventives failed
Clinical pearls
- • Limit acute drugs to <10 days/month to avoid medication-overuse headache
- • Avoid triptans in ischaemic heart disease and hemiplegic migraine
- • Combined oral contraceptive contraindicated in migraine with aura
Related in WardRound
Educational — verify locally.
