Migraine Basics
Migraine without aura typically lasts this long when untreated or unsuccessfully treated.
What is 4-72 hours?
This visual aura may be described as a jagged blind spot, zigzag line, or shimmering scotoma.
What is a fortification spectrum/ scintillating scotoma?
Recurrent unilateral throbbing headaches lasting 1-2 days with nausea, vomiting, and photophobia fit this diagnosis.
What is migraine without aura?
A transient jagged visual disturbance followed by language difficulty and then throbbing headache most strongly suggests this diagnosis.
What is migraine with aura?
This medication class is commonly used for acute migraine when NSAIDs are inadequate and there are no contraindications.
What are triptans?
These are two common associated symptoms of migraine and are part of the ICHD-3 criteria
What are nausea/vomiting and photophobia/phonophobia?
This type of neurologic symptom is an accepted migraine aura symptom and can involve difficulty speaking or writing.
What is speech/language aura?
The 1-2 day duration of symptoms argues against this headache disorder, which usually lasts 15-180 minutes.
What is cluster headache?
The patient’s 10-15 minutes of language dysfunction falls within this typical aura duration window.
What is 5-60 minutes?
Preventive therapy should be considered once patients reach this number of headache days per month.
What is 4 or more headache days per month?
Chronic migraine requires this number of headache days per month for more than 3 months.
What is ≥15 headache days per month?
This dangerous vascular mimic must be considered in a first episode of transient aphasia.
What is TIA or stroke?
Ipsilateral ptosis during headache should raise consideration of this group of headache disorders.
What are trigeminal autonomic cephalalgias?
In transient language aura, inability to produce coherent words with preserved comprehension is better described as this, rather than dysarthria
What is expressive aphasia?
Regular use of triptans on this many days per month can contribute to medication-overuse headache.
What is ≥10 days per month?
ICHD-3 requires this number of attacks to formally diagnose migraine with aura.
What are at least 2 attacks?
Gradual spread, positive symptoms, and sequential symptoms favor migraine aura over this diagnosis.
What is TIA?
This autonomic symptom can occur in migraine and does not automatically prove cluster headache.
What is ptosis?
A patient presents with a first-ever transient language deficit followed by migraine-like headache. Even if migraine aura is suspected, this initial diagnostic test is needed to evaluate for acute ischemia or hemorrhage.
What is urgent neuroimaging, typically non-contrast CT head initially, with MRI brain if available?
Topiramate, beta-blockers, TCAs, SNRIs, CGRP monoclonal antibodies, and gepants are examples of this treatment category.
What are migraine preventive therapies?
This term describes frequent migraine that does not yet meet chronic migraine criteria.
What is high-frequency episodic migraine?
Thunderclap onset, papilledema, fever, cancer, immunosuppression, or a new focal deficit are examples of these.
What are headache red flags?
A patient with unilateral migraine attacks has ipsilateral ptosis during headaches. In migraine, this reflects activation of this reflex pathway, which can produce cranial autonomic symptoms.
What is the trigeminal-autonomic reflex?
A right-handed patient develops transient impaired speech production, writing errors, and difficulty reading after a visual aura, while comprehension is relatively preserved.
What is Broca’s area / dominant inferior frontal gyrus?
In a 33-year-old woman with frequent episodic migraine who needs preventive therapy, this can be used as a first-line preventive option and may be dosed monthly.
What is fremanezumab/Ajovy?