HPI: Migraine.
I discussed headaches with the patient which appear to be migraines. We went over the following:
International Headache Society
A. At least 5 headaches fulfilling B-D
B. HA lasting at 4-72 hours (untreated or unsuccessfully tx)
C. HA with at least 2 of the following:
1. Unilateral Location
2. Pulsating Quality
3. Moderate to Severe Pain Intensity
4. Aggravated by or causing avoidance of activity
D. During HA at least one of the following:
1. Nausea and/or Vomiting
2. Photophobia or Phonophobia
E. Not attributable to another disorder
Notes:
Differentiating between "Migraine without aura" and "Infrequent episodic tension-type headache may be difficult." Therefore at least 5 attacks are required.
Individuals who otherwise meet criteria for Migraine without aura but have had fewer than 5 attacks should be coded "Probable migraine without aura"
In children, attacks may last 1-72 hours (although the evidence for untreated durations of less than 2 hours in children requires corroboration by prospective diary studies).
When attacks occur on =15 days/month for >3 months, code as "Migraine without aura" and as "Chronic migraine."
Migraine headache is commonly bilateral in young children; an adult pattern of unilateral pain usually emerges in late adolescence or early adult life.
Migraine headache is usually frontotemporal. Occipital headache in children, whether unilateral or bilateral, is rare and calls for diagnostic caution; many cases are attributable to structural lesions.
