I. Concepts related to migraine Migraine is characterized by episodic, mostly lateral, moderately severe, throbbing headache, usually lasting 4 to 72 h. It may be accompanied by nausea and vomiting, and the headache may be aggravated by light, sound or activity, and relieved by rest in a quiet environment. Migraine in childhood is mostly seen in males, with shorter attacks, more bilateral headache and gastrointestinal symptoms, less aura, photophobia and phonophobia symptoms can be inferred from their behavior. Sometimes it manifests as periodic vomiting or abdominal pain. Aura refers to a completely reversible focal neurological symptom that occurs before or along with headache and manifests as visual, sensory, verbal, and motor deficits or irritation symptoms. Most auras are visual symptoms, often binocular and isotropic, such as blurred vision, dark spots, flashes of light, bright spots and lines, or distorted vision. Sensory symptoms are mostly distributed in one hand area of the face. Aura symptoms usually develop gradually within 5 to 20 min and last no more than 60 min. different aura can appear one after another. The main types of migraine are migraine without aura (common migraine) and migraine with aura (classic migraine). Migraine was once diagnosed as “vascular headache”, “neurogenic headache” or “vascular-neurogenic headache”, but since 1988, the International Headache Society (IHS) no longer After 1988, the International Headache Society (IHS) stopped recommending it. The current term “vascular headache” is a secondary headache. Classification and diagnosis of migraine 1. The International Classification of Headache Disorders (ICHD I-2), the second edition of IHS in 2004, classifies migraine as primary headache, including six subtypes, with migraine without aura and migraine with aura being the most common. The diagnosis of migraine is mainly based on clinical manifestations. When taking medical history, attention should be paid to the location, nature, degree, duration, accompanying symptoms, aura manifestations and the influence of activities on the headache. The patient’s headache diary helps in the diagnosis. In clinical practice, secondary headaches should be ruled out first, and then whether they are accompanied by other types of primary headaches should be considered. Neuroimaging should be performed in the following cases: (l) abnormal neurological findings; (2) acute increase in the frequency or degree of headache; (3) change in the nature of headache; (4) new onset of headache or sudden onset of severe headache after the age of 50; (5) headache that has failed to respond to multiple treatments; (6) other symptoms such as dizziness and numbness. EEG, TCD and other tests are not recommended as routine diagnostic tests. The diagnostic criteria developed by IHS are operational and are the most commonly used diagnostic tools. If the headache after a typical aura is not consistent with migrainous headache, it should be diagnosed as a typical aura with non-migrainous headache; if there is no headache attack after a typical aura, it should be diagnosed as a typical aura without headache; if the aura shows weakness of the limbs, it should be diagnosed as hemiplegic migraine if there are similar attacks in their first-degree relatives, it should be diagnosed as familial hemiplegic migraine, otherwise it should be diagnosed as sporadic hemiplegic migraine. Aura was diagnosed as basal migraine when it showed involvement of nerve tissues innervated by the posterior circulatory system, such as dysarthria, vertigo, tinnitus, hearing loss, diplopia, simultaneous visual symptoms in bilateral nasal or bilateral temporal visual fields, ataxia, altered consciousness, and bilateral sensory abnormalities, but not limb weakness. If only one item is worse than the diagnostic criteria, but does not meet the diagnostic criteria of other headaches, it can be diagnosed as a likely migraine. III. Treatment of migraine Firstly, we should strengthen the education to make patients understand the pathogenesis, clinical manifestations and treatment process of headache, so as to relieve unnecessary worries and improve the compliance of treatment. Encourage patients to make a headache diary. The basic principles of migraine prevention and treatment: (l) help patients establish scientific and correct concepts and goals of prevention and treatment; (2) maintain a healthy lifestyle; (3) find and avoid various migraine triggers; (4) make full use of non-pharmacological interventions, including massage, physical therapy, biofeedback therapy, cognitive-behavioral therapy and acupuncture; (5) pharmacological treatment includes two categories: acute attack treatment and preventive treatment. Chinese medicine is widely used, but more evidence-based medical evidence is needed. 1. Acute attack treatment The purpose of acute attack treatment is to rapidly relieve pain, eliminate concomitant symptoms and restore daily functions. There are two types of treatment: non-specific treatment and migraine-specific treatment. Non-specific treatment drugs include: (l) non-street anti-inflammatory drugs (NSAIDs), such as p-acetaminophen, aspirin, ibuprofen, sodium cyproheptadine and their compound preparations; (2) barbiturates and other sedative drugs; (3) opioids. The latter two types of drugs are addictive and should be used with caution, only for severe cases where other treatments are ineffective. Specific therapeutic drugs are: (l) ergot preparations. (2) Tretinoin-based drugs. Drug selection needs to be considered according to the severity of headache, concomitant symptoms, previous medication and other factors. A stepwise approach to drug selection can be used, with NSAIDs preferred and poor results followed by a switch to migraine-specific drugs. It is also possible to select drugs in a stratified manner, with NSAIDs being chosen for mild to moderate headache, severe headache but previous attacks responding well to NSAIDs; and migraine-specific drugs being chosen directly for moderate to severe headache and poor response to NsAIDs. In case of severe nausea and vomiting, parenteral administration is preferred. Gastrofacial and domperidone antiemetic and gastrodynamic drugs can not only treat concomitant symptoms but also facilitate the absorption of other drugs and the treatment of headache. Acute treatment should be used as early as possible, but should not be used more than once to avoid causing drug abuse headache. 2.Preventive treatment: The purpose is to reduce the frequency of attacks, alleviate the degree of attacks, reduce functional damage and increase the efficacy of treatment during acute attacks. The principles of preventive treatment are: (1) to exclude the abuse of analgesic drugs; (2) to select drugs with precise efficacy and few adverse effects in an evidence-based manner; (3) to start with small doses and gradually increase the dosage; (4) to evaluate the efficacy within 4-8 weeks; (5) to adhere to a sufficient course of treatment, usually 3-6 months; (6) to establish the right expectation of prevention to help improve treatment compliance. Indications: (l) an average of at least 2 attacks per month or headache days of more than 4 d in the last 3 months; (2) ineffective acute phase treatment or inability to undergo acute phase treatment due to side effects and contraindications; (3) use of analgesic drugs at least 2 times per week; (4) special types of migraine, such as hemiplegic migraine, migraine with prolonged aura or migrainous infarction; (5) patient’s tendency; (6) menstrual migraine. Commonly used medications include: (1) calcium antagonists, of which there is more evidence-based evidence for flunarizine hydrochloride; (2) p-adrenergic receptor blockers, of which there is more evidence-based evidence for propranolol and sialol; (3) antiepileptics, such as valproic acid and topiramate; (4) tricyclic antidepressants, such as amitriptyline; (5) 5-HT antagonists, such as benzathine; (6) others: high-dose vitamin B2, magnesium, botulinum toxin A local injection and traditional Chinese medicine. The selection of drugs should take into account the individual situation of the patient and the pharmacological effects and side effects of the drugs.