History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include: family history of migraine; female sex; menstruation; stressful life events; obesity; sleep disorders; medication overuse.
prolonged headache
A headache that lasts 4 to 72 hours if untreated is suggestive of migraine.[3]
decreased ability to function
The severe headache and associated features such as nausea often reduce the patient's ability to function.
headache worse with activity
Migraine is commonly made worse with routine daily activities as well as exercise.[3][39]
A useful feature when trying to distinguish between migraine and other primary headaches. Tension-type headache is not made worse by exertion, and patients with cluster headache are often restless or agitated and cannot keep still.
sensitivity to light
sensitivity to noise
unilateral
Migraine is often unilateral. However, it is bilateral in slightly less than half of patients, so location does not confirm the diagnosis or rule it out.[3][39]
Headache may shift from side to side during or within attacks; some experts suggest that when this does not occur (side-locked headache), the likelihood of a fixed structural lesion is increased.[54][55]
throbbing sensation
Migraine headache may be perceived as throbbing/pulsating due to increased perception of the normal pulsations of meningeal vessels.[56]
uncommon
Risk factors
strong
family history of migraine
female sex
Migraine is around three times more prevalent among women than men, with young and middle-aged women particularly affected.[8][11]
Some women experience menstrual migraine, which is most likely to occur in the 2 days leading up to a period and in the first 3 days of a period.[27][28] Migraine frequency and severity may also increase during menopause due to hormonal fluctuations.[29]
obesity
stressful life events
There is evidence that stress may be involved in migraine onset and contribute to chronification.[33]
The impact of reducing stress is unknown, but stress management and relaxation techniques are validated treatments for migraines and may be especially helpful for patients who frequently experience stress or cope with it poorly.[33][34]
medication overuse
Overuse of medications for acute migraine can cause chronic migraine.[35]
sleep disorders
Various sleep disorders are linked to migraine, including insomnia (which is by far the most common), snoring and obstructive sleep apnoea, restless legs, circadian rhythm disorders, and narcolepsy.
The presence of a sleep disorder is associated with more frequent and severe migraines, and is also associated with a poorer headache prognosis.[36]
weak
low socio-economic status
Epidemiological studies in the US suggest this is a risk factor for chronic migraines and chronic daily headaches.[6]
allergies or asthma
There is evidence for a relationship between allergies or asthma and migraine prevalence.[37]
hypothyroidism
A positive association has been demonstrated between hypothyroidism and migraine; this may be a bidirectional association.[38]
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