Migraine care: diagnosis thresholds and treatment choices

Guyana Times, in an article by Dr Tariq Jagnarine, explains that the formal ICHD-3 criteria for migraine without aura in adults include at least five attacks lasting 4 to 72 hours when untreated or unsuccessfully treated. Each headache must have at least two of four features—one-sided location, pulsating quality, moderate or severe intensity, or worsening with routine physical activity—and must involve nausea or vomiting, or both light and sound sensitivity. Symptoms must not be better explained by another headache diagnosis. The article stresses that this threshold does not mean someone with fewer attacks should be left untreated: a clinician may consider probable migraine while assessing the pattern and excluding other causes.

Care also depends on the difference between treating an attack and preventing future ones. Paracetamol or ibuprofen may help if taken early and suitable; a clinician may prescribe sumatriptan for a more disabling attack, and metoclopramide may help with prominent nausea or vomiting. These medicines appear on Guyana’s published Essential Medicines List, but stock may vary by facility. Regular prevention, such as propranolol, may be considered when attacks are frequent, disabling, or disruptive despite appropriate attack treatment; propranolol is listed for specialist use. Other options noted are amitriptyline and topiramate. Choices depend on medical conditions, potential adverse effects, pregnancy plans and access. The article also distinguishes possible triggers—such as missed meals, irregular sleep, stress, dehydration, excess caffeine and bright light—which vary between patients, rather than applying the same restrictions to everyone. A brain scan is not routinely needed to confirm typical migraine, though a changed headache pattern or concerning examination findings may warrant further investigation.