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 likely secondary to activation of the trigeminovascular system cortical spreading depression may explain aura Precipitating factors include emotional stress odors lights females hormones Epidemiology affects 12% of the general population more common in females migraine without aura is more common not uncommon to have a family history Presentation Symptoms pulsating/throbbing quality length usually 4-72 hours long unilateral (usually) do not exclude migraine if headache is bilateral nausea/vomiting debilitating aura (~25% of cases) there is complete reversability of symptoms positive symptoms visual - more common (e.g., bright lines, bright shapes) auditory (e.g., tinnitus) somatosensory (e.g., parasthesias) negative symptoms e.g., loss of vision photophobia phonophobia Evaluation Clinical diagnosis Differential Tension headache Medication overuse headache Meningitis Subarachnoid hemorrhage Treatment Acute (Abortive) Therapy Preventive (Prophylactic) Therapy Simple analgesics NSAIDs acetaminophen Triptan Dihydroergotamine Prochloperazine Metoclopramide β-blockers Tricyclic antidepressants Topiramate Valproate Prognosis, Prevention, Complications Complications status migranosus