Migraine Headache Questions & Answers

Updated: May 28, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Questions & Answers

Overview

What is migraine headache?

What are the signs and symptoms of migraine headache?

What are some features of migraine aura?

Which physical findings are characteristic of migraine headache?

What are the International Headache Society diagnostic criteria for migraine headache?

What are the classifications of migraine headache?

What are some migraine variants?

What is the role of lab and imaging studies in the diagnosis of migraine headaches?

Which common management practices for migraine headache were deemed unnecessary by the American Headache Society as part of the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign?

Which types of pharmacologic agents are used in the treatment of migraine headaches?

What are acute (abortive) medications used to treat migraine headache?

When is prophylactic therapy indicated for migraine headache?

Which prophylactic medications are used for migraine headache?

Which nonpharmacological treatments may be used for migraine headache?

What is migraine headache?

What is the origin of the term migraine?

What are the causes of migraine headache?

How is migraine headache characterized?

How is migraine headache diagnosed?

What are the treatment options for migraine headache?

How are migraine headaches classified?

What are the International Headache Society criteria for diagnosing a migraine headache?

What changes were made to the International Classification of Headache Disorders for migraine headache in 2018?

Where can guidelines for the diagnosis, treatment, and prevention of migraine headaches be found?

What is the migraine center theory of migraine headache pathogenesis?

What is the vascular theory of migraine headache pathophysiology?

What are limitations of the vascular theory of migraine headache pathophysiology?

What is the neurovascular theory for migraine headache pathophysiology?

What is the role of cortical spreading depression (CSD) in the pathogenesis of migraine headache with aura?

What is the role of oligemia in the pathogenesis of migraine headache?

What is the role of the trigeminovascular system in the pathogenesis of migraine headaches?

What is the role of metalloproteinases in the pathogenesis of migraine headache?

What is the role of hypoxia in the pathogenesis of migraine headaches?

What are the neurogenic aspects of migraine headache pathogenesis?

What is the role of brainstem activation in the pathogenesis of migraine headaches?

What is the role of cutaneous allodynia in the pathogenesis of migraine headache?

Why is the dopaminergic theory of migraine headache pathogenesis?

What is the role of magnesium deficiency in the pathogenesis of migraine headache?

What is the role of endothelial dysfunction in the pathogenesis of migraine headache?

What is the role of serotonin in the pathogenesis of migraine headache?

What are the predisposing vascular risk factors for migraine headache?

How does medication overuse affect migraine headache?

What are the genetics factors in the etiology of migraine headache?

What is familial hemiplegic migraine (FHM)?

What is the genetic cause of familial hemiplegic migraine (FHM) type 1?

What is the genetic cause of familial hemiplegic migraine (FHM) type 2?

What is the genetic cause of familial hemiplegic migraine (FHM) type 3?

Which genetic disorders are associated with migraine headaches?

What is cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)?

How are migraine headaches caused by genetic vasculopathies?

What are migraine headache precipitants?

Which foods are precipitants of migraine headache?

What are the vascular risks associated with migraine headache?

What is the role of iron in the etiology of migraine headache?

What is the association between migraine headache and sensory perception deficits?

What is the prevalence of migraine headache in the US?

How does the prevalence of migraine headache vary by sex and age?

How does the prevalence of migraine headache vary by race?

What is the economic impact of migraine headache in the US?

What is the global prevalence of migraine headache?

What is the relationship between socioeconomic status and migraine headache prevalence?

What is the prognosis of migraine headache?

What are the risk factors for stroke in patients with migraine headache?

Which factors increase the risk of vascular diseases in patients with migraine headache?

Where can patients go to learn more about migraine headache?

Presentation

What are the typical characteristics of migraine headache?

What are the signs and symptoms of migraine headache?

What are prodromal symptoms of migraine headache?

What is migraine headache aura?

What are the negative visual symptoms of migraine headache aura?

What are the positive visual symptoms of migraine headache aura?

What are symptoms of migraine headache sensory aura?

What are motor symptoms of migraine headache?

What is the course and significance of the aura in migraine headache?

What are the postdromal symptoms of migraine headache?

What are migraine headache triggers?

How much does a family history increase the risk of migraine headache?

How is disability assessed in patients with migraine headache?

Which findings on neurological exam suggest migraine headache?

How is a non-migraine headache differentiated from migraine during the physical exam?

Which physical findings suggest a more serious cause of headache other than migraine?

What are ophthalmic migraines?

What are the diagnostic criteria for migraine headache?

How does the International Headache Society define migraine headache aura?

What are migraine variants?

What is the childhood periodic syndromes o migraine variant?

What are symptoms of basilar-type migraine?

What is the late-life migrainous accompaniments migraine variant?

What is hemiplegic migraine?

What is ophthalmoplegic migraine?

What is retinal migraine?

What is status migrainosus?

What is chronic migraine?

What are comorbidities of migraine headache?

How prevalent are migraine headache comorbidities?

How much does asthma increase the risk for migraine headache?

What are complications of migraine headache?

Which risk factors for stroke are correlated with migraine headache?

DDX

How is primary headache disorder differentiated from migraine headache?

Which features of a secondary headache disorder should be considered in the differential diagnosis of migraine headache?

What is a crash migraine?

What is an exertional headache?

How is an intracranial aneurysm differentiated from a migraine headache?

How is aneurysmal subarachnoid hemorrhage (SAH) evaluated in the differential diagnosis of migraine headache?

Why are space-occupying lesions included in the differential diagnosis of migraine headaches?

How is cerebral venous thrombosis differentiated from migraine headache?

When should spontaneous internal carotid artery dissection be included in the differential diagnosis of migraine headache?

When should secondary causes of migraine headache be considered?

What are the differential diagnoses for Migraine Headache?

Workup

How is migraine headache diagnosed?

What is the role of lab testing and imaging studies in the evaluation of migraine headache?

Which diagnostic tests for migraine headache may be unnecessary according to the American Headache Society's Choosing Wisely recommendations?

How does insurance status affect migraine care?

What is the role of neuroimaging in the evaluation of migraine headaches?

What is the role of CT scanning and MRI in the evaluation of migraine headaches?

When is lumbar puncture (LP) indicated in the evaluation of migraine headache?

Treatment

What are the goals of migraine headache treatment?

Which specialists should be consulted in the treatment of migraine headache?

What is the initial emergency department (ED) treatment of migraine headache?

What are the options for emergency department (ED) care of migraine headache?

When is hospitalization indicated in the treatment of migraine headache?

How are migraine headache triggers managed?

What are nonpharmacologic therapy options for migraine headache?

What is the efficacy of Cerena Transcranial Magnetic Stimulator (Cerena TMS) for the treatment of migraine headache?

What are contraindications for the use of the Cerena Transcranial Magnetic Stimulator (Cerena TMS) to treat migraine headache?

What is the efficacy of nonpharmacologic management for migraine headache?

What is the role of a vagus nerve stimulator in the treatment of migraine headache?

Which medications are used for abortive treatment of migraine headache?

What is the role of analgesics in the treatment of migraine headaches?

Which analgesics are used for the treatment of migraine headache?

Which medications are used to treat severe pain of migraine headaches?

What treatment options for acute migraine?

Which triptans and ergot alkaloids are used in the treatment of migraine headache?

What is the role of triptans in the treatment of migraine headache?

What are contraindications for the use of triptans and ergot alkaloids for migraine headache?

How are migraine headache-related nausea and vomiting treated?

When is prophylactic migraine therapy indicated?

What are the goals of preventive therapy for migraine headache?

How do prophylactic medications for migraine work?

What should be considered before administering preventive drugs for migraine headache?

Which drugs have been FDA approved for migraine prophylaxis?

Which medication are used to relieve allodynia caused by migraine headache?

What is the role of naproxen sodium in the management of migraine headache?

What is the role of quetiapine in the treatment of migraine headache?

Which classes of medications are effective for migraine prevention?

What is the role of antiepileptics in migraine prevention?

What is the role of antidepressants in migraine prevention?

What is the role of antihypertensives in migraine prevention?

What is the role of botulinum toxin A (onabotulinumtoxinA; BOTOX®) in migraine prevention?

What is the role of calcitonin gene-related peptide (CGRP) inhibitors in migraine prevention?

Which devices are used for migraine prophylaxis?

What are the treatment options for status migrainosus?

What are the treatment options for menstrual migraines?

What is the role of complementary and alternative medicine (CAM) in migraine treatment?

What is the efficacy of herb butterbur as a prophylactic treatment for migraine headaches?

What is the efficacy of riboflavin as a prophylactic treatment for migraine headaches?

What is the effectiveness of coenzyme Q10 (CoQ10) as a prophylactic treatment for migraine headaches?

What is the effectiveness of melatonin as a prophylactic treatment for migraine headaches?

Which complementary and alternative medicine (CAM) techniques lack proven efficacy in the prevention of migraine headache?

What are the advantages and disadvantages to complementary and alternative medicine (CAM) therapies for the prevention of migraine headaches?

What is the role of surgical therapy for migraine headaches?

What are common dietary triggers of migraine headaches?

What are some sources of tyramine that may dietary trigger for migraine headaches?

What is the role of nutraceuticals in migraine prophylaxis?

What is the role of activity modification in the management of migraine headaches?

What is the role of tonabersat in the treatment of migraine headache?

What medications are being investigated as possible treatments for acute migraine headaches?

Guidelines

Which medications are recommend by the AAN and AHS as effective for migraine prevention?

Which medications are probably effective for migraine prevention according to AAN and AHS guidelines?

Which medications are possibly effective for migraine prevention according to AAN and AHS guidelines?

Which CAM therapy is established as effective for migraine prevention according to AAN and AHS guidelines?

Which NSAIDS and CAM therapies are probably effective for migraine prevention according to AAN and AHS guidelines?

Which NSAIDS and CAM therapies are possibly effective for migraine prevention according to AAN and AHS guidelines?

What are the AHS guidelines for ED management of acute migraine?

What are the updated AHS guidelines on the prevention and acute treatment of migraine headache?

Medications

What are the classifications for pharmacologic agents used to treat migraine headaches?

What are abortive medications for the treatment of migraine headache?

What are prophylactic medications for the treatment of migraine headache?

Which medications in the drug class Neuromuscular Blocker, Botulinum Toxins are used in the treatment of Migraine Headache?

Which medications in the drug class CGRP Monoclonal Antibodies are used in the treatment of Migraine Headache?

Which medications in the drug class Antidepressants, SSRIs are used in the treatment of Migraine Headache?

Which medications in the drug class Calcium Channel Blockers are used in the treatment of Migraine Headache?

Which medications in the drug class Tricyclic Antidepressants are used in the treatment of Migraine Headache?

Which medications in the drug class Beta Blockers, Beta-1 Selective are used in the treatment of Migraine Headache?

Which medications in the drug class Antihistamines, 1st Generation are used in the treatment of Migraine Headache?

Which medications in the drug class Anticonvulsants are used in the treatment of Migraine Headache?

Which medications in the drug class Antiemetic Agents are used in the treatment of Migraine Headache?

Which medications in the drug class Antipsychotics, Phenothiazine are used in the treatment of Migraine Headache?

Which medications in the drug class Analgesics, Barbiturates Combos are used in the treatment of Migraine Headache?

Which medications in the drug class Analgesics, Other Combos are used in the treatment of Migraine Headache?

Which medications in the drug class Analgesics, Opioid Combos are used in the treatment of Migraine Headache?

Which medications in the drug class NSAIDs are used in the treatment of Migraine Headache?

Which medications in the drug class Opioid Analgesics are used in the treatment of Migraine Headache?

Which medications in the drug class Analgesics, Other are used in the treatment of Migraine Headache?

Which medications in the drug class Ergot Derivatives are used in the treatment of Migraine Headache?

Which medications in the drug class Serotonin 5-HT-Receptor Agonists are used in the treatment of Migraine Headache?