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Adult Migraine (with or without aura)
For any referral, the patient must be recorded to have been tried on prophylaxis for 8-10 weeks following dose titration. If this is not recorded the referral will be returned for addition.
Suspect migraine in people who present with or without headache and with neurological symptoms that:
Diagnose migraine with aura in patients who present with or without headache and with one or more of the following symptoms that meet the criteria listed below:
Consider further investigations, e.g. brain imaging and/or referral for patients with or without migraine headache and with any of the following atypical aura symptoms:-
Neurological examination + BP
CRP if any question of Temporal Arteritis
If there is a fixed neurological deficit the patient will need a brain imaging
The acute and prophylactic medical management in Primary Care can be found in the formulary
For a referral, the patient must have tried prophylaxis for 8-10 weeks following dose titration. If this is not recorded the referral will be returned for addition.
A headache diary for 3 months from the patient can help with decisions about on-going treatment.
National Institute for Health and Clinical Excellence (2012) [Headaches: Diagnosis and management of headaches in young people and adults]. [CG150].
British Association for the study of Headache (2010) [Guidelines for all Healthcare Professionals in the Diagnosis and Management of: Migraine, Tension-Type, Cluster and Medication-Overuse Headache]. [3rd Edition]
This guideline has been signed off by Dr Alex Rowe - GP and Clinical Lead for Planned Care South Devon and Torbay CCG.
Author: S Weatherby, Consultant Neurologist, PHNT / Dr G Lenden Clinical lead DRSS Western
Publication date: January 2017