Migraine pathway

 

Adapted from SIGN 107 - diagnosis and management of headache in adults

Start

  1. Aspirin 900 mg or ibuprofen 400mg

  2. Paracetamol 1g ( mild-moderate)

 Use of triptans
Take at beginning of headache phase of migraine

If not controlled with simple analgesics Add a triptan

  1. Sumatriptan 50 - 100mg

  2. Try an alternate triptan if sumatriptan doesn’t give relief

 Migraine
  Secondary 
headache

At presentation

  1. Take careful history

  2. Full neurological examination

  3. Check BP

  4. Check fundi


Consider

  1. Headache diary

  2. Headache impact diary

Red flag symptoms

  1. Associated relevant neurological signs

  2. Associated new onset seizure

  3. Significant unexplained change in headache character

  4. Migraine aura > 1hr

  5. New headache > 50yr old

  6. Headache precipitated by Valsalva manoeuvre

  7. Headache that changes with posture

  8. Headache that wakes from sleep

  9. H/O HIV

  10. H/O cancer

Add

  1. To sumatriptan 50-100mg

  2.   add Naproxen 500mg

For nausea/ vomiting

  1. Add oral or rectal anti-emetic

  2. Domperidone

  3. Metoclopramide

 Commencing therapies
Discuss risk of medication overuse headache
 Frequent Migraines
Consider prophylaxis
Consider
 Stress management
 Acupuncture