Migraine Prophylaxis and Acute Management
CGRP inhibitors, triptan protocols, and diagnostic criteria for primary headache disorders.
ICHD-3 Diagnostic Criteria for Migraine without Aura
At least five attacks fulfilling criteria B-D:
- B. Headache attacks lasting 4-72 hours (untreated)
- C. Headache has at least two: unilateral location, pulsating quality, moderate/severe pain intensity, aggravation by routine physical activity
- D. During headache at least one: nausea and/or vomiting, photophobia and phonophobia
Prophylactic Therapy
Considered when migraines occur ≥4 days/month or cause significant disability.
- Beta-blockers: Propranolol, metoprolol
- Antiepileptics: Topiramate, valproate
- Anti-CGRP Monoclonal Antibodies: Erenumab, fremanezumab, galcanezumab
Common Clinical Mistakes
- Premature anchoring on common diagnoses without evaluating red flags.
- Over-reliance on neuroimaging while neglecting detailed physical exams.
- Suboptimal dosing of first-line agents before declaring treatment failure.
Frequently Asked Questions
- When is immediate specialist referral required?
- Urgent referral is indicated for sudden onset of severe symptoms, rapidly progressive deficits, or when standard therapies fail.
- What are the primary outcome measures in recent clinical trials?
- Most contemporary trials focus on slowing disease progression (e.g., EDSS in MS, UPDRS in Parkinson's) and reducing relapse/event rates.
- How does this condition impact patient life expectancy?
- While highly variable, modern disease-modifying therapies have significantly improved long-term survival rates across neurodegenerative and neuroimmunological disorders.