Migraine
Migraine is a neurological condition causing recurrent, often disabling headache attacks, diagnosed per ICHD-3 criteria and treated per American Headache Society (AHS) consensus statements.
Symptoms
Attacks lasting 4-72 hours with moderate-to-severe, often one-sided, pulsating pain, worsened by routine activity, accompanied by nausea and/or sensitivity to light and sound; some people experience an aura (visual or sensory changes) beforehand.
Causes and risk
A genetic predisposition combined with triggers -- stress, skipped meals, sleep changes, hormonal fluctuations, weather changes, and alcohol are among the most commonly reported; female sex and family history raise underlying risk.
How it is evaluated
Diagnosis is clinical, based on symptom pattern; neuroimaging is reserved for atypical presentations or red-flag features rather than done routinely, per current NEJM guidance.
Treatment
Acute treatment includes NSAIDs and triptans, with gepants and ditans as options when those aren't effective or are contraindicated. For prevention, CGRP-targeted therapies (monoclonal antibodies and oral gepants) were elevated to first-line status in the AHS 2024 consensus statement, alongside older preventive medication classes. Triptans carry cardiovascular contraindications and all acute medications carry a risk of medication-overuse headache if used too frequently.
When to seek care
A "thunderclap" headache -- sudden, severe pain reaching maximum intensity within seconds to minutes -- is a medical emergency requiring immediate evaluation to rule out a bleed in the brain, per the SNNOOP10 red-flag framework. A headache with fever, neck stiffness, new neurological symptoms, or occurring after head trauma should also be evaluated urgently.