Snapshot A 31-year-old female presents with a headache that is throbbing and affecting the right-side of her head. She also reports nausea and had one episode of vomiting. Her symptoms began approximately 8 hours ago, where she began to see a bright light that progressively expanded, making it difficult for her to see. Sitting in a quiet dark room improves her symptoms. Medical history is insignificant. She denies alcohol, smoking, or illicit drug use. Introduction Episodic primary headache disorder login to view 2 more bullets Epidemiology Affects 12% of the general population More common in females Migraine without aura is more common Not uncommon to have a family history Risk factors login to view 10 more bullets Presentation Symptoms login to view 17 more bullets Differential Tension headache Medication overuse headache Meningitis Subarachnoid hemorrhage diagnosis Clinical diagnosis Treatment Acute (Abortive) Therapy Preventive (Prophylactic) TherapySimple analgesicsNSAID sacetaminophenTriptancan cause vasospasm (stroke and MI) in particular when combined with DHE)Dihydroergotamine (DHE)overuse can cause ergotismsymptomsmiosis, psychiatric changes, burning pain in the skin, chest pain, seizures, bradycardia, and hypertensionProchloperazinecan cause acute dystonic reactions such as oculogyric crisisMetoclopramideSecond-line treatmentsvalproic acidβ-blockersTricyclic antidepressantsTopiramateValproate Complications Status migranosus