Patients who otherwise meet the criteria for migraine without aura with fewer than five attacks should be classified as having probable migraine without aura.
If the patient falls asleep during migraine and wakes up without it,
the duration of the attack is until the time of awakening.
In children, attacks may last 1–72 hours.
When attacks occur on ≥15 days/month for >3 months, the patient should be classified as having migraine without aura and chronic migraine.
Migraine headache is commonly bilateral in young children. An adult pattern of unilateral pain generally 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.
Pulsating means throbbing or varying with the heartbeat.
In young children, photophobia and phonophobia may be inferred from their behaviour.
History and physical and neurological examinations do not suggest headache or facial pain attributed to: (i) head and/or neck trauma,
(ii) cranial or cervical vascular disorder, (iii) non-vascular intracranial disorder, (iv) a substance or its withdrawal, (v)
infection, (vi) a disorder of homoeostasis, (vii) disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures or (viii) a psychiatric disorder; or history and/or physical and/or neurological examinations do suggest such a disorder but it is ruled out by appropriate investigations; or such a disorder is present but attacks do not occur for the first time in close temporal relation to the disorder.
