GPAtlas🧭 When to suspect
Suspect migraine in anyone with recurrent, stereotyped attacks of moderate-to-severe headache, often with nausea and sensitivity to light and sound. It is the commonest disabling primary headache disorder, affecting roughly 1 in 7 people (around 10 million in the UK), and the diagnosis is entirely clinical – no blood test or scan confirms it. Untreated attacks last 4–72 hours in adults, and 1–72 hours in young people aged 12 to 17.
Many attacks have a prodrome (hours to 2 days before: fatigue, yawning, neck stiffness, mood or appetite change) and a postdrome (fatigue, low mood and poor concentration for up to 48 hours after the pain settles). Recognising these phases aids both diagnosis and the timing of treatment.
The two practical skills in primary care are to apply the diagnostic criteria confidently – so as to avoid unnecessary imaging – and to never miss a red flag pointing to a secondary headache.
| Type | Diagnostic criteria |
|---|---|
| Episodic migraine | Headache on < 15 days per month. |
| Chronic migraine | Headache on ≥ 15 days per month for > 3 months, with migraine features on at least 8 of those days. |
| Migraine without aura (≥ 5 attacks) | Headache lasting 4–72 hours, plus ≥ 2 of: unilateral, pulsating, moderate/severe, or aggravated by routine activity; and ≥ 1 of: nausea/vomiting, or photophobia and phonophobia. |
| Migraine with aura (≥ 2 attacks) | One or more fully reversible aura symptoms (visual, sensory, or speech/language) developing gradually over ≥ 5 minutes, each lasting 5–60 minutes; headache usually follows within 60 minutes. |
Source: NICE CG150 · International Classification of Headache Disorders (ICHD-3)
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