At least 5 attacks fulfilling criteria B–D (for migraine without aura).
is a neurological disease characterized by recurrent, disabling headache attacks occurring on fewer than 15 days per month . It is the most common form of migraine, affecting approximately 90% of the migraine population. Unlike its counterpart, Chronic Migraine (CM), EM allows for symptom-free intervals between attacks. However, EM is not merely "occasional headache"; it is a complex, genetically-influenced brain disorder involving neuronal hyperexcitability, vascular changes, and pain pathway dysregulation. Without proper management, a significant subset of patients with EM can transition to Chronic Migraine —a process known as chronification.
, sufferers experience "auras"—shimmering lights, blind spots, or tingling in the limbs that act as a surreal precursor to the pain. The Attack (The Storm): This is the peak, featuring debilitating throbbing (usually on one side of the head), extreme sensitivity to light and sound, and often nausea or vomiting. The Postdrome (The Migraine Hangover): Once the pain subsides, it leaves behind a state of exhaustion and cognitive "fog" that can last for 24 hours. The "Invisible" Burden The unique challenge of episodic migraine is the what is episodic migraine
| Drug Class | Examples | Evidence Level | Common Side Effects | |------------|----------|----------------|----------------------| | | Propranolol, metoprolol | High | Fatigue, cold extremities, bradycardia | | Anticonvulsants | Topiramate, valproate | High (topiramate) | Paresthesias, word-finding difficulty, weight loss (topiramate); teratogenicity | | Antidepressants | Amitriptyline, venlafaxine | Moderate | Dry mouth, sedation, weight gain | | CGRP mAbs | Erenumab, galcanezumab, fremanezumab | High | Injection site reactions; low systemic toxicity | | Gepants (oral preventive) | Atogepant, rimegepant | High | Constipation, nausea | | Botulinum toxin A | OnabotulinumtoxinA | Only for chronic migraine | Neck weakness, dysphagia (rare) |
Headache attacks lasting 4–72 hours (untreated or unsuccessfully treated). At least 5 attacks fulfilling criteria B–D (for
Migraine is highly genetic (polygenic). If one parent has it, there is a 50% chance; if both parents have it, the risk rises to 75%.
Treatment is divided into acute (abortive) and preventive (prophylactic). Unlike its counterpart, Chronic Migraine (CM), EM allows
Headache has at least 2 of the following 4 characteristics:
| Drug Class | Examples | Best for | Key Caution | |------------|----------|----------|--------------| | | Sumatriptan, rizatriptan, eletriptan | Moderate-severe pain, with nausea | Not in cardiovascular disease; max 2-4 doses/week to avoid MOH | | Gepants (CGRP receptor antagonists) | Ubrogepant, rimegepant | Triptan intolerance, cardiovascular risk | No vasoconstriction; mild nausea possible | | Ditans (5-HT1F agonists) | Lasmiditan | Triptan non-responders, CV risk | Dizziness, fatigue common; no vasoconstriction | | NSAIDs | Ibuprofen, naproxen, diclofenac | Mild-moderate pain | Gastric irritation; limit use | | Anti-emetics | Metoclopramide, prochlorperazine | Severe nausea/vomiting, also analgesic | Extrapyramidal symptoms (rare) | | Non-specific | Acetaminophen (paracetamol) | Mild pain, pregnancy | Hepatotoxicity at high doses |