Adult Migraine (with or without aura)

Scope

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.

Assessment

Signs and Symptoms

Suspect migraine in people who present with or without headache and with neurological symptoms that:

  • are fully reversible and
  • develop gradually, either alone or in succession, over at least 5 minutes and
  • last for 5-60 minutes

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:

  • Visual symptoms that may be positive (e.g. flickering lights, spots or lines) and/or negative (e.g. partial loss of vision)
  • Sensory symptoms that may be positive (e.g. pins and needles) and/or negative (e.g. numbness)
  • Speech disturbance

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:-

  • Motor weakness
  • Double vision
  • Visual symptoms affecting one eye
  • Poor balance
  • Decreased level of consciousness

History and Examination

Neurological examination + BP

Investigations

CRP if any question of Temporal Arteritis

If there is a fixed neurological deficit the patient will need a brain imaging

Management

The acute and prophylactic medical management in Primary Care can be found in the formulary

Referral

Referral Criteria

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.

Referral Instructions

e-Referral Service

  • Specialty: Neurology
  • Clinic Type: Headache
  • Service: DRSS-South Devon & Torbay-Neurology- Devon CCG - 15N

Referral Form

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

Evidence

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]

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press

NICE Clinical Knowledge Summaries (CKS). Migraine: treatment in pregnancy or breastfeeding. December 2008.

Pathway Group

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

 

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