Migraine is a primary headache disorder, and the first step in diagnosis is to exclude a secondary headache disorder, i.e., that which is caused by a possibly life-threatening condition. These red flags are sudden onset of headache (thunderclap headache or first-worst headache), age of onset after 50 years, fever, stiff neck. Conversly, signs that point to a primary rather than a secondary headache disorder include a long duration of similar headaches, family history of migraine, and menstrual exacerbation. Response to triptans is not diagnostic of migraine and may be seen in secondary headaches, including subarachnoid hemorrhage and meningitis.
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