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

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

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 ICB - 15N

Referral Form

DRSS referral form

Torbay and South Devon seeking advice form

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 on behalf of NHS Devon.

Author: S Weatherby, Consultant Neurologist, PHNT / Dr G Lenden Clinical lead DRSS Western

Publication date: January 2017