Established Migraine with Acute Worsening

Pre-Worsening Headache Baseline

Age of onset

Migraine diagnosis date

HIPAA: Only the year will appear in summaries

Pain quality and location: throbbing, located on one side of the head

Pain Intensity: moderate-severe

Duration: 4-72 hours, may have prodromal and postdromal stages

Nausea/vomiting, dizziness, sensitivity to light/sound/smell, irritability

Symptoms exacerbated by movement

Symptoms improved by laying in dark quiet room and/or sleep

How many days per week does the patient experience any form of headache? Headache duration?

How many days per week does the patient have a very severe headache? Headache duration?

Features of Current Headache

When did headache worsening begin?

Features of current headache are similar to baseline headache

Features of current headache are different from baseline headache

Pattern or precipitants identified for worsening

Aggravating factors

Relieving factors

Missed days of work or other activities

Screen for Secondary Headaches

Treatment

Past medications (over the counter and/or prescribed) and supplements tried

Non-pharmacologic measures tried (neurostimulation devices, massage, biofeedback, acupuncture)

Recent visits to urgent care/ED for acute treatment? Medications given and effectiveness?

History of hemiplegic migraine, peripheral vascular disease, myocardial infarction, coronary artery disease, uncontrolled hypertension, cardiac arrhythmia, stroke, ischemic bowel disease, severe hepatic disease? (vasoconstrictors such as triptans and dcihydroergotamine are contraindicated)

Diagnostic Evaluation

Prior brain and/or vessel (arterial, venous) imaging performed

Prior lumbar puncture performed

Other diagnostics