• A term normally used to describe a certain type of headache with a suspected vascular cause

Symptoms and Signs

  • Initially one sided (unilateral) and throbbing headache that builds up over the course of several hours
  • Patients prefer dark, quiet rooms
  • Nausea and vomiting
  • Normally subsides within 24hours
  • Auras- can be visual (shimmering lights), sensory (paresthesias), or motor (heaviness of hte limbs)
  • May see neurological deficit


  • 18% of females and 6% of males are affected
  • 75% of individuals with migraines are adult women
  • In children: Boys and girls are equally affected
  • More common in whites than African/Asian Americans


  • Based on clinical history and exam: Additional studies to rule out other causes-
  • CT / MRI
  • Lumbar puncture
  • EEG


  • Medication options have two main goals: Abortive therapy (for an ongoing migraine) and Preventive therapy (to prevent the future occurence of migraines)
  • Abortive: Ibuprofen, Triptans (Imitrex, Maxalt, Axert), Opioids, DHE IV medication
  • Abortive medication overuse (>2 days per week) can lead to analgesic rebound headaches
  • Preventive: Methysergide, Calcium channel blockers, Beta blockers, antidepressants, anticonvulsants



  • Not all severe headaches are due to a migraine and often they are a warning sign to a more severe condition (such as a ruptured aneurysm)
  • In terms of migraines:


Differential Diagnosis

  • Arteriovenous malformation
  • aneurysm
  • Cluster headache
  • Tumor
  • Infection
  • Lupus
  • Temporal arteritis
  • Tolosa-Hunt syndrome