Migraine

Audience: Patients and providers
Status: Clinical guide · patient + provider
Last updated: 2026-03-09

1. Clinical overview

Migraine is a recurrent neurovascular headache disorder with episodic or chronic patterns, sensory hypersensitivity, and major functional impact when acute and preventive strategies are not matched to attack burden.

2. Common causes and risk factors

Neurovascular disorder with trigeminovascular activation and central sensitization.
Common triggers include sleep disruption, stress, hormonal shifts, and diet patterns.

3. Typical symptoms

Recurrent unilateral/bilateral throbbing headache, nausea, photophobia/phonophobia, +/- aura.

4. Diagnosis and evaluation

Confirm diagnosis with guideline-based history, exam, and indicated testing.
Screen for severity, complications, and high-risk comorbid conditions.
Identify social or access barriers that could affect treatment success.

5. Treatment (non-pharmacologic)

Trigger diary, sleep regularity, hydration, exercise, and stress-modulation strategies.
Headache action plan to prevent medication overuse.

6. Treatment (pharmacologic)

Acute treatment commonly uses ibuprofen, naproxen, sumatriptan, rizatriptan, ubrogepant, rimegepant, or lasmiditan depending on phenotype and vascular risk.
Preventive options commonly include propranolol, metoprolol, topiramate, valproate, amitriptyline, venlafaxine, CGRP monoclonal antibodies such as erenumab or fremanezumab, and oral gepants such as atogepant.
Antiemetics such as metoclopramide or prochlorperazine may help nausea-heavy attacks, especially in urgent-care settings.

7. Monitoring and follow-up

Monthly headache days, acute medication use frequency, disability scores, adverse effects.

8. Practical counseling points

Give patients a clear “what to do today / when to call / when to seek urgent care” plan.
Use teach-back to confirm understanding of treatment goals and medication instructions.
Simplify regimens when possible to improve adherence and outcomes.

9. Red flags and escalation

Escalate care urgently for severe or rapidly worsening symptoms.
Reassess diagnosis if expected response does not occur within the anticipated timeline.

10. Guideline references

Note: Educational guide only; not a substitute for individualized medical care.