Leading cause of years lived with disability in young adults
Pathophysiology
Pathophysiology overview
Trigeminovascular activation
Meningeal nociceptor sensitization
Central sensitization
Cutaneous allodynia phenotype
Neurotransmitters and peptides
CGRP involvement
Serotonin pathway involvement
Aura mechanism
Cortical spreading depolarization model
Therapeutic Considerations
Treatment rationale
Dopamine antagonists
Antiemetic plus analgesic benefit
NSAIDs
Peripheral inflammation modulation
Triptans
Serotonin receptor agonism
Steroid single dose
Reduced early recurrence after ED discharge
Medication-overuse prevention
Overuse perpetuates chronic headache cycle
Opioid avoidance rationale
Poor migraine-specific efficacy
Higher relapse and return visits
Patient Discharge Instructions
copy discharge instructions
Discharge packet
Diagnosis
Migraine headache
Home treatment plan
Hydration
Rest in dark quiet room
Early use of prescribed rescue medication
Medication limits
Triptans under 10 days per month
NSAIDs under 15 days per month
Avoid opioids for migraine when possible
Follow-up
Primary care or neurology within 1 to 2 weeks if recurrent
Headache diary
Frequency
Triggers
Medications used
Return to ED now
Sudden severe headache reaching peak within 1 minute
New weakness
New trouble speaking
New confusion
Fainting
Fever
Neck stiffness
New vision loss
Persistent vomiting with inability to keep fluids down
Headache after head injury
Headache in pregnancy with high blood pressure symptoms
Worst headache of life
References
Clinical guidelines and evidence sources
Core references
International Classification of Headache Disorders third edition
Migraine diagnostic criteria framework
Emergency headache clinical policy sources
Imaging and secondary headache evaluation standards
Acute migraine in emergency care evidence syntheses
Dopamine antagonist efficacy
NSAID efficacy
Dexamethasone recurrence reduction
Medication-overuse headache consensus statements
Monthly day thresholds for overuse
Landmark trials and comparative effectiveness
Evidence base
Dopamine antagonist randomized trials
Metoclopramide outcomes
Prochlorperazine outcomes
NSAID trials
Ketorolac outcomes
Steroid adjunct trials
Single-dose dexamethasone relapse reduction
Triptan trials
Subcutaneous sumatriptan rapid relief
DHE protocols
Status migrainosus regimen evidence
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.