Migraine: diagnosis and pharmacologic treatment in emergency department

Acute headache is a common chief complaint in the Emergency Department (ED), accounting for up to 4% of all ED visits. Migraine is a common, chronic, at times incapacitating disorder, characterized by attacks of severe headache, autonomic nervous system dysfunction, and in some patients, an aura characterized by various neurologic symptoms. It is the most common cause of severe, recurring headaches. Although most headaches in the ED are benign, one should be vigilant in searching for "red flags", which may represent dangerous conditions. In addition to properly identifying important secondary causes of headache, the goal of acute therapy is to provide rapid, complete, and sustained relief of pain and associated symptoms without generating significant adverse effects. In many patients, migraine responds well to simple treatment at the time of an attack. In patients with substantial disability, it is appropriate to prescribe a triptan early in the course of treatment, in keeping with a stratified approach to care.