For Patients & General Readers

Migraine is a common neurological condition that causes intense, throbbing headaches, often on one side of the head. It can be accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can significantly impact daily life, making it difficult to work, study, or engage in social activities.

Clinical Overview

Migraine is a complex neurological disorder characterized by recurrent, episodic headaches, typically unilateral and pulsating, often moderate to severe in intensity. It is frequently associated with nausea, vomiting, photophobia, and phonophobia, and can be preceded or accompanied by an aura in some individuals. Pathophysiology involves neurovascular dysregulation, with trigeminovascular system activation and cortical spreading depression playing key roles.

Clinical Presentation

Recurrent headaches, typically lasting 4-72 hours if untreated or unsuccessfully treated.
Headache is typically unilateral in location, though it can be bilateral.
Headache is pulsating in quality.
Headache is moderate or severe in intensity.
Aggravated by or causing avoidance of routine physical activity (e.g., walking or climbing stairs).
Associated with at least one of the following: nausea and/or vomiting, photophobia and phonophobia.

Signs & Symptoms

Symptoms (Patient-Reported)

Throbbing or pulsating head pain
Nausea and/or vomiting
Sensitivity to light (photophobia)
Sensitivity to sound (phonophobia)
Visual disturbances (aura), such as flashing lights, blind spots, or zigzag lines
Neck pain or stiffness
Dizziness or vertigo
Fatigue

Signs (Clinician-Observed)

Normal neurological examination between attacks
Possible mild neurological deficits during an aura (e.g., transient visual or sensory changes)
Patient may appear distressed and seek a dark, quiet room
Tenderness of scalp or temporal arteries (less common)

Differential Diagnoses

Condition	Distinguishing Feature
Tension-type headache	Typically bilateral, non-pulsating, mild to moderate intensity, not aggravated by routine physical activity, and not associated with nausea/vomiting.
Cluster headache	Excruciating, unilateral, orbital/supraorbital/temporal pain, short duration (15-180 minutes), associated with ipsilateral autonomic symptoms (e.g., lacrimation, nasal congestion, ptosis).
Sinus headache	Pain typically localized to the forehead and cheeks, associated with sinus congestion, purulent nasal discharge, and fever. Often exacerbated by bending forward.
Secondary headaches (e.g., subarachnoid hemorrhage, brain tumor, meningitis)	Sudden onset ('thunderclap' headache), focal neurological deficits, altered mental status, fever, nuchal rigidity, or a history of malignancy.
Medication overuse headache	Frequent headaches in patients with a pre-existing headache disorder who overuse acute headache medications.
Cervicogenic headache	Pain referred from the neck, often unilateral, with limited range of motion in the cervical spine.

Red Flags — Seek Immediate Care

Sudden onset of the worst headache of life ('thunderclap' headache)
New onset of headache in patients over 50 years of age
Headache associated with fever, nuchal rigidity, or altered mental status
Headache with focal neurological deficits (e.g., weakness, numbness, speech difficulty, visual field defects)
Headache that worsens with Valsalva maneuver or changes in posture
Headache in immunocompromised individuals

Key Investigations

Clinical diagnosis is typically based on history and physical examination.
Neuroimaging (MRI or CT scan) is indicated in cases of atypical presentation, red flags, or to rule out secondary causes.
Lumbar puncture may be considered if meningitis or subarachnoid hemorrhage is suspected.
EEG is generally not indicated for routine migraine diagnosis.

Management Overview

Management involves acute treatment of individual attacks and preventive strategies for frequent or disabling migraines. Acute treatment often includes NSAIDs, triptans, or gepants, while preventive options include beta-blockers, antiepileptics, antidepressants, CGRP inhibitors, and lifestyle modifications. A multimodal approach tailored to the individual patient's needs and headache characteristics is essential.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. TruelyserMD does not replace clinical judgement.