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Migraine resources for healthcare professionals
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Evidence-based resources that may help you diagnose, treat and evaluate your patients with migraine.
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Selected diagnosis and evaluation tools
Access checklist, questionnaire and guidelines to help educate on tools that can support diagnosis, measure degree of disability and response to treatment of migraine therapies
Selected PROMs (Patient Reported Outcomes Measures)
Type of document: Infographic
- References:
- 1. National Quality Forum. Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care, 2009. Available at: https://www.qualityforum.org/Publications/2010/01/Measurement_ Framework_Evaluating_Efficiency_Across_Patient-Focused_Episodes_of_Care.aspx (accessed July 2023). | 2. Lipton RB, et al. Neurology 2003;61:375–82. | 3. Lipton RB, et al. Headache 2001;41:854–61. | 4. Stewart WF, et al. Pain 2000;88:41–52. | 5. Lipton RB, et al. Cephalalgia 2009; 29:751–9. | 6. Dowson AJ, et al. Curr Med Res Opin 2004;20:1125–35. | 7. Reilly MC, et al. Pharmacoeconomics. 1993;4(5):353-365. | 8. Ford JH, et al. J Patient Rep Outcomes 2023;7:34.
ID Migraine Screener
A quick, 3-question tool designed to help diagnose migraine in a primary care setting.
MIDAS Assessment
Measures the impact of migraine on work, school, and social activities using 5 scorable questions.
mTOQ-5
Helps assess the effectiveness of current acute treatments.
Migraine-ACT
Focuses on assessing the overall effectiveness of migraine treatments.
WPAI: Migraine
Evaluates how migraine affects absenteeism, presenteeism, and overall work productivity.
ID Migraine Screener
Type of document: Questionnaire
- References:
- 1. Lipton RB, et al. Neurology 2003;61:375–82. | 2. de Mattos ACM, et al. Arq Neuro-Psiquiatr 2017;75:446–50
ID Migraine Screener
A quick, 3-question tool designed to help diagnose migraine in a primary care setting.
MIDAS (Migraine Disability Assessment)
Type of document: Questionnaire
- References:
- 1. Lipton RB, et al. Headache 2001;41:854–61. | 2. Stewart WF, et al. Pain 2000;88:41–52.
MIDAS
Questionnaire to help measure the impact headaches have on a patient's life. Helps determine the level of pain and disability caused by headaches.
Migraine Goals and Treatments
Selected evidence-based resources that may help you in your diagnosis, treatment and evaluation of patients with migraine
- Acute treatment
- Preventive treatment
AHS Acute Treatment Goals
Type of document: Consensus statement summary
- References:
- 1. Ailani J, et al. Headache 2021;61:1021–39.
Acute Treatment Goals
Goals of acute treatment from the 2021 AHS Consensus Statement.
AHS Acute Treatment Recommendations
Type of document: Consensus statement summary
- References:
- 1. Ailani J, et al. Headache 2021;61:1021–39.
Acute Treatment Recommendations
Recommendations for the acute treatment of migraine from the 2021 AHS Consensus Statement.
AHS Preventive Treatment Goals
Type of document: Consensus statement summary
- References:
- 1. Ailani J, et al. Headache 2021;61:1021–39.
Preventive Treatment Goals
Goals of preventive treatment from the 2021 AHS Consensus Statement.
AHS Preventive Treatment Recommendations
Type of document: Consensus statement summary
- References:
- 1. Ailani J, et al. Headache 2021;61:1021–39. | 2. Charles AC, et al. Headache 2024; 64:333-41.
Preventive Treatment Recommendations
Recommendations for the preventive treatment of migraine from the 2021 AHS Consensus Statement and 2024 Updated Position Statement.
Educational resources
Find educational documents to expand understanding of migraine
What is Migraine?
Type of document: Infographic
- References:
- 1. Gupta J, Gaurkar SS. Cureus 2022;14(8):e28347. | 2. Eigenbrodt AK, et al. Nat Rev Neurol 2021;17:501–14. | 3. GBD 2016 Headache Collaborators. Lancet Neurol 2018;17:954– 76. | 4. GBD 2017 US Neurological Disorders Collaborators. JAMA Neurol 2021;78:165–76. | 5. Andreou AP, Edvinsson L. J Headache Pain 2019;20:117. | 6. Dodick DW. Lancet 2018;391:1315–30. | 7. American Migraine Foundation. Facts about migraine 2019 (https://americanmigrainefoundation.org/resource-library/migraine-facts/). | 8. Polderman TJC, et al. Nat Genet 2015;47:702.709. | 9. Kelman L. Cephalalgia 2007;27:394–402. | 10. Ashina M, et al. Lancet Neurol 2019;18:795–804. | 11. Woolf, CJ. Pain 2011;152:S2-S15. | 12. Ashina M. N Engl J Med 2020;383;1866–76. | 13. Edvinsson L, et al. Nat Rev Neurol 2018;14:338–50. | 14. Ferrari MD, et al. Nat Rev Dis Primers 2022;8:2. | 15. Khan J, et al. Biomed Pharmacother 2021;139:111557. | 16. American Migraine Foundation. Migraine prodrome: symptoms and prevention 2022 (https://americanmigrainefoundation.org/resource-library/migraine-prodrome-symptoms-prevention/)
Four Stages of Migraine
Prodrome, Aura, Headache, Postdrome.
Genetics
Genetic component to migraine susceptibility exists.
Triggers
Migraine triggers are unique and specific to each patient.
Pathophysiology
ICHD-3 diagnostic criteria
A detailed hierarchical classification of headache-related disorders.
Migraine Comorbidities
Type of document: Infographic
- References:
- 1. Buse DC, et al. J Headache Pain 2020;21:23. | 2. Minen MT, et al. J Neurol Neurosurg Psychiatry 2016;87:741–9. | 3. Buse DC, et al. J Neurol Neurosurg Psychiatry 2010;81:428– 32. | 4. Lipton RB, et al. Headache 2018;58:933–47. | 5. Association of Migraine Disorders. Comorbidities. Accessed November 2023; Available at: https://www.migrainedisorders.org/comorbidities/. | 6. Buse DC, et al. Headache 2020;60:2340–56. | 7. Kumar R, et al. Cureus 2022;14:e26419. | 8. Lipton RB, et al. Headache 2020;60:1683– 96. | 9. Yang Y, et al. Cephalagia 2016;36:679–91
Migraine Comorbidities
Comorbidities are common among people with migraine and may impact its management.
Migraine Diagnosis
Type of document: Infographic
- References:
- 1. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211. | 2. Martin VT, et al. Ann Med;2021:53:1979–90. | 3. Weatherall MW. Ther Adv Chronic Dis;2015:6:115–23. | 4. Ravishhankar K. Ann Indian Acad Neurol 2012;15:7–14. | 5. Dodick DW. Semin Neurol 2010;30:74–81. | 6. Do TP, et al. Neurology 2019;92:134–44. | 7. Pohl H. Headache 2022;62:534–5. | 8. Schwedt TJ. Continuum (Minneap Minn) 2015;21:1058–71. | 9. Eigenbrodt AK, et al. Nat Rev Neurol 2021;17:501–14. | 10. Lipton RB, et al. Neurology 2003;61:375–82. | 11. de Mattos ECM, et al. Arq Neuro-Psiquiatr. 2017;75:446–50. | 12. Lew C, Punnapuzha S. Migraine medications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. | 13. Lambru G, et al. J Headache Pain 2017;18:49. | 14. Lee VME, et al. Singapore Med J 2018;59:399–406. | 15. Park IK, et al. Invest Ophthalmol Vis Sci 2013;54:5249-57.
Migraine Diagnosis
Migraine is a type of primary headache disorder. A thorough headache history is the most important tool in diagnosing migraine.
Red Flags
Red flags include (but are not limited to) sudden headache onset, older age at onset, and headaches precipitated by Valsalva maneuver.
Patient Examination
A physical examination can determine other factors that may exacerbate migraine and includes fundoscopy, palpation of head and neck, cardiovascular screening, and neurologic examination.
Differential Diagnoses of Headache Disorders
Characteristics of primary headache disorders including headache duration, features and frequency.
ID Migraine Diagnostic Aid
The ID Migraine diagnostic aid is a validated, reliable tool that assesses pain and functional activity in previously undiagnosed individuals. It consists of three core questions regarding headache-associated disability, nausea, and photophobia.
Migraine Diagnosis & Treatment
Type of document: Interactive Document
- References:
- 1. Ailani J, et al. Headache 2021;61:1021–39. | 2. Bigal ME, et al. Headache 2008;48:1157–68. | 3. Dodick DW. Semin Neurol 2010;30:74–81. | 4. Eigenbrodt AK, et al. Nat Rev Neurol 2021;17:501–14. | 5. Evans RW. Pract Neurol 2014:26–32. | 6. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211. | 7. Lipton RB, et al. Headache 2018;58:1408–26. | 8. Lipton RB, et al. Headache 2022;62:122–40. | 9. Lucas S. Obstet Gynecol 2019;134:211. | 10. Martin VT, et al. Ann Med 2021;53:1979–90. | 11. Park IK, et al. Invest Ophthalmol Vis Sci 2013;54:5249–57. | 12. Rasmussen BK, Olesen J. Cephalalgia 1992;12:221–8. | 13. Russell MB, Olesen J. Brain 1996;119:355–61. | 14. Serrano D, et al. J Headache Pain 2017;18:101.
ICHD-3
The ICHD-3 (International Classification of Headache Disorders, 3rd Edition) provides diagnostic criteria for three main categories of migraine: migraine without aura, migraine with aura, and chronic migraine.
Distinguishing Characteristics
Includes unilateral location, pulsating pain (moderate to severe), aggravation by physical activity, and accompanying symptoms such as nausea, vomiting, photophobia, and phonophobia.
Pharmacological Treatment
Involves both acute and preventive therapies. Acute treatment is for all patients with a confirmed diagnosis of migraine, while preventive treatment is for those whose attacks significantly interfere with daily routines despite acute treatment.
Differential Diagnoses
Includes other primary headache disorders and some potentially life-threatening secondary headache disorders.
Migraine Triggers
Type of document: Infographic
- References:
- 1. Kelman L. Cephalalgia 2007;27:394–402. | 2. Hoffmann J, et al. Ann Clin Transl Neurol 2015;2:22–8. | 3. Marmura MJ. Curr Pain Headache Rep 2018;22:81. | 4. Lipton RB, et al. Headache 2014;54:1661–9. | 5. Martin VT and Behbehani MM. Med Clin North Am 2001;85:911–41. | 6. Graf M, et al. Headache 2023;63:506–16. | 7. Sauro KM, Becker WJ. Headache 2009;49:1378–86. | 8. Vetvik KG, et al. Cephalalgia 2014;34:280–8. | 9. Haghdoost F, Togha M. Open Med (Wars) 2022;17:1869–82. | 10. Silberstein S, Patel S. Expert Opin Pharmacother 2014;15:2063–70. | 11. Artemenko AR, et al. Headache 2022;62:4–10. | 12. National Headache Foundation. Light and headache disorders: understanding light triggers and photophobia. Available at: https://headaches.org/light-headache-disorders-understanding-light-triggers-photophobia/ (accessed June 2023). | 13. Noseda R, et al. Nat Neurosci 2010;13:239–45. | 14. Hindiyeh NA, et al. Headache 2020;60:1300–16. | 15. Nowaczewska M, et al. Nutrients 2020;12:2259. | 16. Khorsha F, et al. J Clin Neurosci 2020;77:81–4. | 17. Finocchi C et al. Neurol Sci 2012; 33:S77-S80. | 18. Kim J, et al. J Headache and Pain 2017;18:50. | 19. Lin Y-K, et al. Medicine 2016;95:e3554. | 20. Vgontzas A. et al. Headache 2018; 58: 1030–1039. | 21. Martin GV, et al. Cephalalgia 2013;33:375–83. | 22. Bolay H, Rapoport A. Headache 2011;51:1426–30. | 23. Scheidt J, et al. Int J Biometeorol 2013;57:649–54. | 24. Kimoto K, et al. Intern Med 2011;50:1923–8. | 25. Schwedt TJ, et al. Neurology 2022;98:e1409–21. | 26. Kumar R, et al. Cureus 2022;14:e26419. | 27. Schwedt TJ, et al. J Headache Pain 2018;19:38. | 28. Moreno-Ajona D, et al. Curr Opin Neurol 2020;33:309–15. | 29. Diener HS, et al. Lancet Neurol 2019;18:891–902. | 30. Ailani J, et al. Headache 2021;61:1021–39. | 31. Amin FM, et al. J Headache Pain 2018;19:83. | 32. American Migraine Foundation. Exercise and migraine. Available at: https://americanmigrainefoundation.org/resourcelibrary/exercise-migraine/ (accessed June 2023). | 33. Abdullah M, et al. Cureus 2020;12:e10976. | 34. International Headache Society. Cephalalgia 2018;38:1–211.
Identification and Management of Triggers
Patients with migraine are encouraged to identify and manage their unique triggers through self-management strategies.
Potential Migraine Triggers
Multiple factors can lead to a migraine episode, and not all patients respond to the same triggers. Common triggers, pathophysiology, and recommendations are outlined.
Clinical toolkit
Discover an expanded set of tools and resources to help support clinical decision making for migraine
Primary Care Toolkit
Type of document: Interactive Document
- References:
- 1. ACOG Committee on Clinical Practice Guidelines–Obstetrics. Obstet Gynecol 2022;139:944–72. | 2. Ailani J, et al. Headache 2021;61:1021–39. | 3. American Migraine Foundation. Managing and pregnancy: what moms-to-be need to know, 2017: https://americanmigrainefoundation.org/resource-library/migraine-pregnancy/. | 4. American Migraine Foundation. The timeline of a migraine attack, 2018: https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/. | 5. Andreou AP, Edvinsson L. J Headache Pain 2019;20:117. | 6. Ashina M et al. Lancet. 2021;397:1485-98. | 7. Buse DC, et al. Headache. 2013; 53(8):1278–99. | 8. Buse DC, et al. Headache 2019;59:1286-99. | 9. Buse DC, et al. J Headache Pain 2020;21:23. | 10. Buse DC, et al. Headache 2021;61:628–41. | 11. Charles AC, et al. Headache 2024; 64:333-41. | 12. de Mattos ACM, et al. Arq Neuro-Psiquiatr. 2017;75 (7):446-450. | 13. Determan M. Pharmacy Times July 28, 2023. | 14. Do TP, et al. Neurology 2019;92:134–144. | 15. Dodick DW. Semin Neurol 2010;30:74–81. | 16. Dodick DW. Lancet 2018;391:1315–30. | 17. Dodick DW. Continuum (Minneapolis, MN) 2021;27(3):572-85. | 18. Dowson AJ, et al. Curr Med Res Opin 2004;20:1125–35. | 19. Eigenbrodt AK, et al. Nat Rev Neurol 2021;17:501–14. | 20. European Headache Federation. Accessed June 20, 2024. https://static-content.springer.com/esm/art%3A10.1186%2Fs10194-018-0899-2/MediaObjects/10194_2018_899_MOESM16_ESM.pdf. | 21. European Headache Federation. Accessed June 20, 2024. https://static-content.springer.com/esm/art%3A10.1186%2Fs10194-018-0899-2/MediaObjects/10194_2018_899_MOESM17_ESM.pdf. | 22. Evans RW, et al. Headache 2020;60:318-336. | 23. FDA. https://www.accessdata.fda.gov/drugsatfda_docs/NDA/97/020148_migranal_toc.cfm. Accessed April 6, 2022. | 24. FDA. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211280Orig1s000TOC.cfm. Accessed April 6, 2022. | 25. FDA. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=211765. Accessed April 6, 2022. | 26. FDA. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=016762. Accessed May 6, 2022. | 27. FDA. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=018723. Accessed May 6, 2022. | 28. FDA. https://www.accessdata.fda.gov/drugsatfda_docs/bla/2010/103000orig1s5215.pdf. Accessed May 6, 2022. | 29. FDA. https://www.fda.gov/news-events/press-announcements/fda-approves-novel-preventive-treatment-migraine. Accessed May 6, 2022. | 30. FDA. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&varApplNo=212728. Accessed May 6, 2022. | 31. Ferrari MD, et al. Nat Rev Dis Primers 2022;8:2. | 32. Ford JH, et al. J Patient Rep Outcomes 2023;7:34. | 33. GBD 2016 Headache Collaborators. Lancet Neurol 2018;17:954–76. | 34. GBD 2017 US Neurological Disorders Collaborators. 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RATE Mnemonic Framework
An approach to help you remember the steps to recognizing, assessing, treating and evaluating migraine patients.
Diagnostic Guidance
Tools such as patient history assessments, physical exams, and diagnostic criteria (ICHD-3).
Treatment Options
Outlines treatment strategies by medication class for acute and preventive migraine therapy.
Special Considerations
Unique guidelines are provided for treating migraines in specific populations, such as pregnant women and those with chronic conditions, emphasizing individualized care.
Long-term Evaluation
It stresses the importance of continuous evaluation of treatment plans, using validated tools like MIDAS and MTOQ-5, to ensure the effectiveness and adjust care based on patient outcomes.
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