From the Guidelines
Migraine diagnosis is primarily clinical, based on a detailed history of headache characteristics and associated symptoms, as outlined in the International Classification of Headache Disorders (ICHD-3) criteria 1.
Key Diagnostic Criteria
To diagnose migraine, patients should experience at least five attacks lasting 4-72 hours (untreated) with specific characteristics. The diagnosis involves:
- A moderate to severe headache, often one-sided, pulsating in quality, aggravated by routine physical activity
- Accompanied by nausea, vomiting, or sensitivity to light and sound
- At least two of the following characteristics: unilateral location, pulsating quality, moderate to severe intensity, and aggravation by physical activity
- At least one of these symptoms: nausea/vomiting or photophobia/phonophobia
Diagnostic Approach
A detailed medical history is the mainstay of migraine diagnosis, with the assistance of published aids and systematic application of the ICHD-3 criteria 1. Physical examination is most often confirmatory, and further investigations, such as neuroimaging or blood samples, are occasionally required to confirm or reject suspicions of secondary causes for headache.
Use of Diagnostic Tools
While neuroimaging like MRI or CT scans isn't routinely needed, it may be ordered if there are atypical features, neurological abnormalities, or sudden onset of severe headache to rule out secondary causes 1. Blood tests may occasionally be performed to exclude other conditions. A headache diary tracking frequency, duration, intensity, triggers, and associated symptoms is extremely helpful for accurate diagnosis.
From the Research
Diagnosis of Migraine
- Migraine is a common and debilitating condition that affects approximately 12% of the population, making it the second leading cause of years lived with disability worldwide 2.
- The diagnosis of migraine is based on the International Headache Society (IHS) classification, which categorizes migraine headaches into several types, including migraine without aura, migraine with aura, ophthalmoplegic migraine, and retinal migraine 3.
- Diagnostic criteria for migraine include factors such as the location and character of headache pain, the extent to which pain inhibits function, the effect of physical activity on the pain, and the presence of nausea, vomiting, photophobia, or phonophobia 3, 4.
Clinical Features of Migraine
- Migraine is a syndrome characterized by recurrent headaches with or without aura, and triggers may include foods, hormonal changes, and stressors 4.
- Migraine must be differentiated from other unilateral headache disorders and from headaches due to other neurologic and systemic diseases 4.
- The clinical features of migraine may vary, but common symptoms include headache pain, nausea, vomiting, photophobia, and phonophobia 2, 3.
Treatment of Migraine
- Acute treatment of migraine may include analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan 2.
- Metoclopramide, an antiemetic, has also been shown to have pain-relieving effects for migraine and may be considered as a first-line medication for migraine attacks in emergency department settings 5, 6.
- Preventive treatments for migraine may include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which can reduce migraine frequency by 1 to 3 days per month relative to placebo 2.