neurologic disorders
Migraine
Key Points
Migraine is a common primary headache disorder. Symptoms can include throbbing unilateral or bilateral pain, nausea, sensitivity to sensory stimuli (eg, light, sounds, smells), nonspecific prodromal symptoms, and temporary neurologic symptoms that precede headache (auras). Diagnose migraine based on clinical findings; if patients have red flag findings, imaging and other tests are often needed. Involve patients in their care, including avoiding triggers and using biofeedback, stress management, and psychotherapy as appropriate. Treat most headaches with analgesics, IVdihydroergotamine, or triptans. If attacks are frequent and interfere with activities, use preventive therapy (eg, monoclonal antibodies that blockcalcitoningene-related peptide [CGRP],amitriptyline, a beta-blocker, a gepant,topiramate, divalproex),onabotulinumtoxinA, or sometimes neuromodulatory treatments. 