Title: What Makes a Headache a Migraine?<br/>Author: WanTsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><ul>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Migraine is the 2nd most common neurologic disorder after tension headache and accounts for more disability than all other neurologic disorders combined.</span></span></li>
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                <span style="font-family: arial, helvetica, sans-serif; font-size: 14px;">Diagnosis is clinical and defined by at least 5 episodes of headache that meet the following criteria:</span>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Duration of 4 to 72 hours (when untreated or unsuccessfully treated)</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><u>At least 2 characteristics</u>: unilateral, pulsating, moderate-to-severe pain intensity, aggravated by physical activity</span></span></li>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><u>Accompanied by at least 1 symptom</u>: nausea, vomiting, photophobia, phonophobia</span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Aura symptoms must be fully reversible and may be visual, sensory, speech/language, motor, brainstem, or retinal.</span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Early treatment while the headache is still mild include NSAIDs followed by triptans.</span></span>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Opioids and barbiturates are not recommended due to adverse effects and risk of dependency.</span></span></li>
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                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Preventive treatment is recommended for patients who have at least 2 migraine days per month and whose lives are adversely affected.</span></span>
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                                <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Common therapies include antihypertensive agents (e.g. propranolol), antidepressants (e.g. amitriptyline), anticonvulsants (e.g. topiramate, valproate), and calcium-channel blockers (flunarizine).</span></span></li>
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        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><u>Bottom Line</u>:</strong> Migraine is a common and debilitating condition that benefits from early treatment. Consider initiating preventive therapy for patients who experience at least 2 migraine days per month and adverse effects despite treatment.</span></span></span></span></p>
<fieldset><legend>References</legend>

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                Ashen M. Migraine. <em>N Engl J Med</em>. 2020;383(19):1866-76.</li>
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