Patient handout

Migraine

PRODUCTION

1. Your condition

This handout is for migraine. Your care team identified this based on: recurrent unilateral throbbing headache 4–72h (aan 2024).

Other reasons your team may use this plan: visual / sensory / language aura preceding headache (aan 2024); photophobia, phonophobia, nausea/vomiting (aan 2024); ≥4 headache days/month interfering with function (aan 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ibuprofen	400–800 mg PO at onset	PO	PRN; max 3 d/week to avoid MOH	AHS 2025 — high-dose NSAID first-line for mild-moderate; cap days/month to prevent MOH
naproxen	500–550 mg PO at onset	PO	PRN	Longer half-life; useful for menstrual migraine (AAN 2024)
acetaminophen	1000 mg PO at onset	PO	PRN	Pregnancy-safe option (AAN 2024)

Plan: Acute attack treatment ladder (AAN 2024)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — No headache or stable baseline (AAN 2024)

If you have:

No or mild headache
Function normal
Acute meds <2 days/week

Do this:

Take preventive as prescribed every day
Maintain trigger control: regular sleep, hydration, meals, exercise
Track in headache diary
Keep follow-up appointments

YELLOW — Active migraine attack (AAN 2024)

If you have:

Attack onset (early aura or pain) (AAN 2024)
Pain ≥4/10 with photophobia / nausea
Function impaired

Do this:

Take rescue medication (NSAID, triptan, or gepant) at first sign of attack — earlier is better
Move to quiet, dark, cool environment
Hydrate; small meal if nausea allows
May repeat triptan once at 2 h if needed; do NOT exceed daily max
Use ondansetron / metoclopramide for nausea if prescribed

Call your provider if:

Attack lasts >24 hours despite acute treatment
Using rescue meds >2 days/week consistently (MOH risk)
New aura features or aura without headache

RED — Medical alert — possible secondary headache or status migrainosus (AAN 2024)

If you have:

Sudden thunderclap "worst-of-life" headache
New focal weakness, vision loss, speech change, or confusion
Headache with fever and neck stiffness
Headache after head injury
Headache during pregnancy with vision change or RUQ pain
Headache lasting >72 hours despite treatment (status migrainosus)

Do this:

Call 911 / go to ED now
Do NOT take additional triptans / ergots — risk if non-migraine cause
Bring medication list

Call your provider if:

Any red-zone trigger — go directly to ED

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Any SNOOP10 red flag (thunderclap, focal deficit, papilloedema, age >50, pregnancy/postpartum, immunocompromised, anticoagulated, post-trauma) (AAN 2024)
Aura with focal deficit lasting >60 min OR new aura pattern (AAN 2024)
Pregnancy + new aura + BP >140/90 OR RUQ pain (AAN 2024)
Hemiplegic migraine — fully reversible motor aura (ICHD-3 1.2.3); familial (FHM with CACNA1A/ATP1A2/SCN1A) or sporadic (SHM)
Migraine with brainstem aura (formerly basilar-type) — ≥2 of: dysarthria, vertigo, tinnitus, hyperacusis, diplopia, ataxia, decreased consciousness (ICHD-3 1.2.2)

5. Follow-up

Reassess at 3 mo; switch CGRP class if no ≥50% response; lifestyle (sleep/hydration/exercise/CBT for headache); comorbidity treatment (depression/anxiety/obesity) (AAN 2024)

6. Sources

Guideline: ICHD-3 (Olesen Cephalalgia 2018) + AHS 2024 Acute Treatment Consensus + AHS 2021 Preventive Consensus + AHS 2024 Position Statement (CGRP first-line preventive) + PREEMPT (onabotulinumtoxinA in chronic migraine) + ACP 2025 Prevention Guideline + AHS 2025 ED Acute Treatment