Migraine (adult)

This algorithm addresses the management of migraine, including for patients in the acute care setting (e.g., emergency department).

In acute care settings the likelihood of a severe headache being caused by an alternative and sometimes life-threatening condition is significant, so careful evaluation may be necessary before concluding the headache is due to migraine.

Urgent evaluation needed?
Initiate acute therapy with or without preventive treatment
Is the patient pregnant or breastfeeding?
Referral to Migraine management: Pregnancy and breastfeeding
Neurology eConsult or consult
Consider neurology consult

Primary Authors: Jonathan H. Smith, MD and Ivan Garza, MD

Secondary Authors: Scott D. Eggers, MD and Deborah J. Rhodes, MD

Input and Recommendations: Mohamad Bydon, MD, Bryan T. Klassen, MD, Suresh Kotagal, MD, Ruple S. Laughlin, MD, Eugene L. Scharf, MD, Cheolsu Shin, MD, Jerry W. Swanson, MD, MHPE and W. Oliver Tobin, MB, BCh, BAO, PhD

AHS editors: Adam S. Sprouse Blum, MD, Carol A. Barch, MN, FNP-BC, Hope O’Brien, MD, MBA, Scott Litin, MD, Mia T. Minen, MD, MPH, Matthew S. Robbins, MD, Kathleen B. Digre, MD

Disclaimer: The opinions expressed here are solely those of the authors and reviewers. The AHS does not provide medical advice or recommendations. As with all flowcharts, clinical judgement in each individual situation must be considered.   Additionally, this webpage is subject to the AHS Legal Notice and Disclaimers found at https://americanheadachesociety.org/web-site-legal-notice-and-disclaimers/.