The mnemonic POUND is an evidence-based aid for the diagnosis of migraines that carries the 6 diagnostic criteria for migraines from the IHS. Criteria #2 and #4 are required + two or more from the remaining 4 criteria.
- Pulsating, throbbing, or varies with the heartbeat.
- One to three day ( i.e. 4-72 hrs in duration) recurring HA. NB: When the patient falls asleep during a migraine and wakes up without it, duration of the attack is reckoned until the time of awakening.
- Unilateral location, usually frontotemporal. In children, it is often bilateral and switches to unilateral in the adolescent years.
- Nausea / Vomiting AND/OR sensitivity to light or sound (Photophobia / Phonophobia).
- Disabling intensity. i) Pain intensity is moderate to severe (vs. tension HA that is mild to moderate). Physical activity restriction: The HA is either aggravated by routine physical activity or causes avoidance of routine physical activity (e.g. walking or climbing stairs). Migraines get worse with movement. Migraines hate Movement!
“In a primary care setting, the probability of a migraine is 92 percent in patients who report at least four of the five POUND symptoms. The probability decreases to 64 percent in patients with three of the symptoms, and 17 percent in patients with two or less symptoms.” AAFP
**Alternate mnemonic: POUNDS as in, a migraine POUNDS your head. The S represents Sensitivity to light and sound (Photophobia and phonophobia)
- Pulsating
- One to 3 days
- Unilateral location
- N/V
- Disabling intensity
- Sound/light sensitivity
Sources:
International Headache society (IHS) classification of Migraines