In this episode of OSCE Talk, we cover how to counsel a patient with migraine — a common OSCE and clinical scenario.

We walk through:

• How migraine typically presents (with and without aura)

• Common triggers and red flags you must not miss

• How to explain migraine in clear, patient-friendly language

• Step-by-step management: lifestyle advice, acute treatments, and prevention

• When to escalate, safety-net, and refer

This episode builds on our headache history episode and focuses specifically on clear, structured counselling, helping you feel confident explaining migraine to patients in OSCEs and real-life practice.

• Migraine is usually a unilateral, throbbing headache that can be severe and disabling

• Migraine may occur with or without aura (visual, sensory, or nausea symptoms)

• Common triggers include alcohol, chocolate, caffeine, stress, and poor sleep

• Migraine with aura is a contraindication to the combined oral contraceptive pill

• Conservative management focuses on trigger avoidance and lifestyle modification

• First-line treatment includes simple analgesia (paracetamol, NSAIDs)

• Triptans (e.g. sumatriptan) can be used for acute attacks

• Preventative options may include beta-blockers or specialist therapies

• Always safety-net worsening headaches, neurological symptoms, fever, or sudden onset