Neurology

Migraine

Recurrent unilateral throbbing headache with photophobia, phonophobia and nausea. Trigeminovascular activation and CGRP release drive attacks; disabling in 15% of adults.

Last reviewed 11 Jun 2026 - MedicoMedics editorial team

Migraine cortical spreading depression

Pathophysiology

Cortical spreading depression triggers trigeminovascular activation and CGRP release, causing meningeal vasodilation and neurogenic inflammation.

Sources: ICHD-3 (Cephalalgia 2018;38:1); AHS 2024 (Headache 2024;64:1)

Presentation

Unilateral throbbing headache 4-72 h with nausea, photophobia and phonophobia. 25% have aura (visual scintillations, sensory or aphasic).

Diagnosis

Clinical using ICHD-3 criteria. Neuroimaging only for red flags: thunderclap, focal deficit, new after age 50, immunosuppression.

Management

Acute: triptans, NSAIDs, gepants (rimegepant), lasmiditan. Preventive: propranolol, topiramate, anti-CGRP mAbs (erenumab, fremanezumab), onabotulinumtoxinA for chronic migraine.

Sample USMLE-style MCQs

Try 5 questions on this topic. Practice hundreds more free with a trial.

Question 1

A 32-year-old woman has monthly unilateral throbbing headaches with photophobia. Best acute therapy?

Question 2

Which agent is contraindicated in a migraineur with uncontrolled hypertension and Prinzmetal angina?

Question 3

A 28-year-old with 6 migraine days/month wants prophylaxis. Best first-line?

Question 4

Which peptide is targeted by newer migraine biologics?

Question 5

Patient uses sumatriptan 15 days/month with worsening daily headache. Diagnosis?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 11 Jun 2026 by MedicoMedics editorial team.

  1. ICHD-3 (Cephalalgia 2018;38:1)
  2. AHS 2024 (Headache 2024;64:1)

Frequently asked

Are gepants safe in coronary disease?

Yes - unlike triptans, gepants and lasmiditan do not cause vasoconstriction.

What defines chronic migraine?

Headache >=15 days/month for >3 months, >=8 with migraine features.

Which aura is most common?

Visual (scintillating scotoma) in ~90% of aura cases.

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