Is the patient pregnant or breastfeeding?
NO
YES
Treatment consistently and satisfactorily improves attack severity?
YES
Referral to Migraine management Pregnancy and breastfeeding
Moderate-severe headache
Consider reasons for failure of nonspecific medication, adjust therapy, reasses after 3 to 4 migraine episodes
Reassess in 6-12 Months
Neurology eConsult or consult
Consider reasons for treatment failure and consider alternative therapy if ineffective
Start a migraine specific treatment
Initiate common analgesics
Mild headache
Classify by severity of attack
Acute Treatment Plan
Select a Path
NO
Outpatient workup
Initiate acute therapy with or without preventive treatment
Education on management principles
NO
ED Management
YES
NO
YES
Urgent evaluation needed?
Atypical signs or symptoms?
Diagnose Migraine
Perform History and Physical Examination
Headache: suspect migraine
Consider neurology consult
YES
NO
YES
NO
Continue preventive treatment for 1 to 2 years, consider tapering
Goals of prevention met?
Consider reasons for failur of prevention, adjust therapy, reassess in 3-6 months
Goals of prevention met?
Continue preventive treatment for 1 to 2 years, consider tapering
Initiate prevention
Preventive Treatment Plan
Preventive Treatment Plan