CME Topic Diagnosis and Management of Migraine Headaches

Migraine headaches afflict approximately 6% of men and 18% of women in the United States, and cost billions of dollars each year in lost productivity, absenteeism, and direct medical expenditures. Despite its prevalence and the availability of therapeutic options, many patients do not seek treatment, and among those who do, a significant portion are misdiagnosed. Correct diagnosis can be made by identifying the historic and physical examination findings that distinguish primary headache disorders from secondary headache disorders, as well as the key clinical features that distinguish migraine headaches from other types. Once diagnosis is made, improper or inadequate management of headache pain, related symptoms such as nausea, and the possible aggravating side-effects of pharmacologic therapies represent further obstacles to effective therapy. Dissatisfaction with migraine therapy on the basis of these factors is common. Among abortive therapy options there are delivery methods available which may avoid aggravating symptoms such as nausea. Recommended pharmacologic agents include nonsteroidal anti-inflammatory drugs, intranasal butorphanol, ergotamine and its derivatives, and the triptans. Indications for prophylactic in addition to abortive therapy include the occurrence of headaches that require abortive therapy more than twice a week, that do not respond well to abortive therapy, and which are particularly severe. Research is ongoing in the pathophysiology of migraines, evaluation of nonpharmacologic treatment modalities, assessment of new drug therapies, and validation of headache guidelines.