Q: You have been called to ER to evaluate a 42 year old female - known as a frequent flyer to ER - for complaint of severe headache. Medical record shows multiple normal CT scans. Patient described her headache as pulsatile, started few hours ago, unilateral and is associated with severe nausea. What would be the best way to avoid unnecessary workup and ICU admission and to document migraine?




Answer:  The mnemonic POUND has been used widely as an evidence-based criteria for diagnosis of Migraine

• Pulsatile quality of headache 
• One-day duration (four to 72 hours if untreated) 
• Unilateral location 
• Nausea or vomiting 
• Disabling intensity

Probability of migraine is 92 percent in patients who report at least four of the five POUND symptoms.



 Reference: 

Ebell MH. Diagnosis of migraine headache. Am Fam Physician. 2006;74(12):2087–2088.