Most importantly, migraines are cyclical headaches, which come, go, and recur.  An attack typically lasts more than four, & less than 72, hours.  Formal diagnostic criteria:

  • 2 of the following 4 characteristics: pulsating, unilateral, moderate or severe intensity, exacerbated by normal activity; and
  • 1 of the following 2 characteristics: nausea / vomiting, or photophobia plus phonophobia.

Up to 60% of patients experience a prodrome 1-2 days prior, with mood changes, perhaps increased yawning.  Up to 25% have an aura, including a variety of evolving visual or sensory symptoms, lasting 5-60 minutes immediately before headache onset.

Research criteria require 5 separate episodes; clinicians wing it with fewer.  A diagnostic trial of abortive migraine therapy (i.e. triptans) may be helpful.  If cyclical headaches occur very frequently, with only one or two suggestive characteristics, consider a trial of migraine prophylaxis with beta-blockers, calcium channel blockers, or tricyclic antidepressants.

See posting “Recurrent Headaches.”