Migraine headache

Revision as of 15:12, 16 June 2015 by Kghaffarian (talk | contribs) (added treatment reference)


Definition: Migraine Headache without Aura

  • 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


  • If pt has at least 4 of the following 5 "POUNDing" features LR of migraine is 24
  1. Pulsatile quality
  2. duration of 4-72 hOurs
  3. Unilateral
  4. Nausea or vomiting
  5. Disabling in quality

Differential Diagnosis






Aseptic Meningitis


See Also


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