From the Guidelines
To assess for migraines, healthcare providers should ask about headache characteristics, associated symptoms, triggers, and impact on daily functioning, following the International Headache Society Classification of Headaches and the ICHD-3 criteria, as outlined in the most recent guidelines 1. When evaluating a patient for migraines, it is essential to start by asking about pain location, quality, intensity, and duration, as these characteristics are crucial in distinguishing migraines from other headache types.
- Inquire about pain location (typically unilateral)
- Quality (throbbing/pulsating)
- Intensity (moderate to severe)
- Duration (4-72 hours if untreated) Associated symptoms such as nausea, vomiting, photophobia (light sensitivity), phonophobia (sound sensitivity), and whether physical activity worsens the pain should also be assessed.
- Ask if the patient experiences aura symptoms (visual disturbances, sensory changes, speech difficulties) before headache onset
- Determine headache frequency, pattern, and timing
- Identify potential triggers such as stress, hormonal changes, certain foods, alcohol, sleep disturbances, or environmental factors
- Assess impact on daily activities, work, and quality of life Family history is important as migraines have a genetic component, and reviewing medication use, including over-the-counter pain relievers, can help check for medication overuse headache, as recommended in recent guidelines 1. A thorough medical history, including age at onset of headache, duration of headache episodes, frequency of headache episodes, pain characteristics, accompanying symptoms, aura symptoms, and history of acute and preventive medication use, is essential for the application of the ICHD-3 criteria, as outlined in the most recent study 1. Healthcare providers should prioritize these questions to guide appropriate treatment strategies and improve patient outcomes, reducing morbidity, mortality, and enhancing quality of life 1.
From the Research
Assessment of Migraines
To assess for migraines, the following questions and considerations can be taken into account:
- What are the symptoms of the headache, such as nausea, vomiting, photo- and phonophobia, and malaise? 2
- How often do the migraine attacks occur, and do they respond to acute treatment? 2, 3
- Are there any associated symptoms such as photophobia and phonophobia? 4
- What is the severity of the headache, and how does it affect daily activities? 5, 4
- Has the patient tried any medications for migraine, such as triptans, ergotamine, or dihydroergotamine? 2, 5, 4
- Are there any contraindications for certain medications, such as triptans? 5
- Has the patient undergone any physical examination to identify extracranial causes of migraine headache? 6
Treatment Options
Treatment options for migraines can include:
- Analgesics like aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) 2
- Triptans, such as sumatriptan, which are highly effective in treating migraine attacks 2, 5, 4
- Metoclopramide, which may have pain-relieving effects for migraine 5, 4
- Preventive treatment, such as beta-blockers, calcium channel blockers, or antiepileptic drugs, for frequent headaches 2, 3
- Behavioral strategies, such as avoiding medication overuse headaches and using low-dose medication with careful titration and monitoring of headache frequency 3