| For Clinicians | For Patients | |----------------|---------------| | EM is defined by <15 headache days/month. | Track your headache days on a calendar or app. | | Overuse of acute medication (triptans, opioids, combination analgesics) drives chronification. | Do not take triptans more than 10 days/month. | | Prophylaxis is underprescribed; consider at 4+ migraine days/month. | If you have ≥4 attacks/month, discuss prevention with your doctor. | | CGRP monoclonal antibodies are first-line for refractory EM with high frequency. | Lifestyle regularity is as important as medication. | | Always screen for medication-overuse headache in EM patients worsening over time. | Migraine is a neurological disease—not a character flaw. |

Evidence-based approaches are vital for EM.

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.

Historically, migraine was thought to be vascular (vasoconstriction/dilation). We now understand it is primarily .

The hypothalamus (especially the suprachiasmatic nucleus) is now considered the master trigger. It processes homeostatic signals (sleep, hunger, stress, circadian rhythm). Abnormal hypothalamic activation occurs the headache phase, explaining prodromal symptoms like yawning, food cravings, or fatigue.

According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), Episodic Migraine is defined by specific features, excluding other headache types.

Treatment is divided into acute (abortive) and preventive (prophylactic).

| Condition | Distinguishing Features | |-----------|--------------------------| | | Bilateral, pressing/light pressure (not throbbing), mild/moderate, no nausea or photophobia+phonophobia simultaneously | | Sinus headache | Facial pressure, purulent nasal discharge, fever; actually most "sinus headaches" meet migraine criteria | | Cluster headache | Severe, orbital/periorbital, 15–180 min, autonomic features (tearing, rhinorrhea, ptosis), circadian periodicity | | Medication-overuse headache | Worsening headache with frequent acute medication use; improves after withdrawal | | Thunderclap headache | Sudden onset to peak <1 min—consider subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome (RCVS) |

Indicated when: ≥4 migraine days/month, disabling attacks, or acute medication overuse risk.