In clinical practice, we often see a lot of patients who come to the clinic for headache, some are migraine and some are not. I. What is migraine? Migraine is an episodic migraine headache with nausea and vomiting that occurs again after a break. It may be relieved in a quiet, dark environment or after sleep. Second, is migraine always a headache on one side? The answer is no. Migraine pain can be located on both sides, and migraine headache on both sides is not uncommon in clinical practice. 3. What is the classification and performance of migraine? Migraine is generally classified into migraine without aura and migraine with aura. Migraine without aura is the most common in clinical practice, with high frequency of attacks, which can seriously affect the work and life of patients. It is characterized by recurrent frontal-temporal pain on one or both sides, which is pulsating in nature and may be accompanied by nausea, vomiting, photophobia, phonophobia, sweating, general discomfort and scalp tenderness. There can also be a clear relationship with menstruation. Migraine with aura may be preceded by or occurring with headache with some aura symptoms, such as visual aura: blurred vision, dark spots, flashes, bright spots, bright lines or distortion of vision; sensory aura, speech and motor aura are rare. The headache is often accompanied by nausea, vomiting, photophobia or phonophobia, pallor or sweating, polyuria, irritability, odor terror, and fatigue, etc. The head and facial edema and temporal artery prominence are also seen. The headache can be aggravated by activity and relieved by sleep. The headache can last for 4 to 72 hours, and after it subsides, there are often fatigue, tiredness, irritability, weakness and poor appetite, etc. It can often improve after 1 to 2 days. What should migraine sufferers pay attention to in their life? In life, migraine patients should pay attention to avoid strain, emotional tension and anxiety, stress and relaxation afterwards, too much or too little sleep; diet should pay attention to avoid cheese containing tyrosine, meat and pickled food containing nitrite, chocolate containing phenylethylamine, food additives containing monosodium glutamate and wine; some drugs such as oral contraceptives and vasodilators such as nitroglycerin can also trigger migraine. V. What kind of headache should be distinguished from migraine? Before making a diagnosis, CT or MRI examination is needed to exclude some diseases in the brain, such as cerebrovascular disease, intracranial aneurysm and occupational lesions. Tension-type headache is a bilateral occipital or whole head constricting or pressure headache, often persistent, rarely accompanied by nausea and vomiting, but in some cases it can also be paroxysmal or throbbing headache. It is mostly seen in young and middle-aged women. Emotional disorders or psychological factors can aggravate headache symptoms. 2. Cluster headache is a rare episodic severe pain around one side of the orbit, lasting from 15 minutes to 3 hours, with attacks ranging from once every other day to several times a day. It is characterized by repeated intensive attacks, but always unilateral headache, and is often accompanied by ipsilateral conjunctival congestion, lacrimation, runny nose, forehead and facial sweating, and Horner’s sign. Tolosa-Hunt syndrome, also known as painful ophthalmic muscle palsy, is a paroxysmal intractable posterior and periorbital swelling, stabbing or tearing pain, accompanied by motoneurosis, talipes and/or adductor nerve palsy, which may occur simultaneously with pain or within two weeks after the onset of pain. MRI or biopsy may reveal granulomatous lesions in the cavernous sinus, supraorbital fissure or orbit. The disease can resolve on its own after a few weeks, but it is easy to recur. Appropriate glucocorticoid treatment can relieve the pain and ocular muscle palsy within 72 hours. 4.Symptomatic migraine Headache originated from vascular lesions of head and neck such as ischemic cerebrovascular disease, cerebral hemorrhage, unruptured saccular aneurysm and arteriovenous malformation; headache originated from non-vascular intracranial disease such as intracranial tumor; headache originated from intracranial infection such as brain abscess and meningitis. These secondary headaches can also be clinically manifested as migraine-like headaches, which may be accompanied by nausea and vomiting, but without the typical migraine attack process; most cases have focal neurological deficits or irritation symptoms, and cranial imaging can show the lesions. Headache with internal environmental disorders, such as hypertensive crisis, hypertensive encephalopathy, eclampsia or pre-eclampsia, may manifest as bilateral throbbing headache, and the timing of headache is closely related to elevated blood pressure. 5.Drug overdose headache (people who use drugs for a long time should be alert) is a secondary headache. Drug overdose mainly refers to too frequent and regular use, such as a fixed number of days per month or per week. Clinically, it is common to take ergotamine, treprostin, opiates ≥ 10 days per month regularly or simple painkillers ≥ 15 days per month for more than 3 months, and the headache occurs or worsens significantly during the overdose of the above drugs. Headache occurrence is drug-related and may be migraine-like or mixed headache of both migraine and tension-type headache nature, with the headache resolving or returning to the original headache pattern within 2 months after drug discontinuation. Drug overuse headache is ineffective for preventive treatment measures, so it is extremely important to make a correct diagnosis. VI. Is there any minimally invasive treatment for migraine after pharmacological treatment has failed? Clinical treatment of migraine should usually be administered immediately at the onset of symptoms. Therapeutic drugs include non-specific analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, and specific drugs such as ergot agents and traptans. Drug selection should be individualized based on the degree of headache, concomitant symptoms, and previous medication use. However, clinically we often face the situation that we take many drugs orally but the effect is average and the headache still bothers us. In this case, the most effective clinical method is stellate ganglion block, which is a minimally invasive treatment method that can relieve headache by injecting drugs into the stellate ganglion of the neck. It is also well accepted by patients!