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.”