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Migraine

Hemicrania (migraena) · Migréna

What it is

A brain-wide excitability disorder with throbbing pain, not a 'bad headache'.

Symptoms & signs

  • Throbbing one-sided pain
  • nausea
  • light and sound hatred
  • aura (zigzags, numbness)
  • 4–72 h attacks

🚩 Get help if…

  • call 112 / 911 now Sudden worst-ever headache, peaking within a minute
  • call 112 / 911 now Headache with weakness, slurred speech or confusion
  • see a doctor soon New headache after 50
  • see a doctor soon Headache that wakes you or keeps getting worse

Where it strikes

Medical treatment

  • Triptans for the attack trials support
  • Gepants — somewhat weaker than triptans, and usable when triptans are not trials support
  • CGRP antibodies — about 1 to 2 fewer migraine days a month than placebo, at a high price mixed evidence
  • Topiramate — effective and dulls thinking for many mixed evidence
  • Propranolol mixed evidence
  • Amitriptyline mixed evidence
  • OnabotulinumtoxinA (Botox) for chronic migraine — roughly 2 fewer headache days a month than placebo mixed evidence
  • Remote electrical neuromodulation (Nerivio) — FDA-cleared 2019
  • Non-invasive vagus stimulation (gammaCore) — FDA-cleared 2018 for migraine

Natural & lifestyle

  • Regular sleep and meals
  • magnesium 400–600 mg
  • riboflavin 400 mg
  • CoQ10
  • butterbur (PA-free)
  • feverfew
  • hydration
  • trigger diary
  • aerobic exercise

Emerging & experimental

  • Ketogenic diet trials
  • single-dose psilocybin trials

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Acupuncture — trials show it prevents attacks about as well as some drugs trials support
  • Melatonin 3 mg at night — one trial matched amitriptyline mixed evidence
  • Ginger at the start of an attack — a small trial matched sumatriptan mixed evidence
  • Chiropractic manipulation — trials disagree; a small risk of neck-artery injury mixed evidence
  • Cannabis — patient reports and small studies early / small studies

ICD codes