What are the diagnostic criteria for migraine, including migraine with aura and migraine without aura?

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Last updated: October 9, 2026 • View editorial policy

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Migraine Diagnostic Criteria

Migraine diagnosis is based on the ICHD-3 (International Classification of Headache Disorders, 3rd edition) criteria, which provide specific operational definitions for migraine without aura, migraine with aura, and chronic migraine. 1

Migraine Without Aura (Most Common Type)

Requires at least 5 attacks fulfilling all of the following criteria: 1

Attack Duration

  • Headache lasts 4-72 hours when untreated or unsuccessfully treated

Headache Characteristics (Need ≥2 of 4)

  • Unilateral location
  • Pulsating quality
  • Moderate or severe pain intensity
  • Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs)

Associated Symptoms (Need ≥1)

  • Nausea and/or vomiting, OR
  • Both photophobia AND phonophobia

Exclusion

  • Not better accounted for by another ICHD-3 diagnosis

Migraine With Aura

Requires at least 2 attacks fulfilling the following criteria: 1

Aura Symptoms (Need ≥1 fully reversible)

  • Visual (most common)
  • Sensory
  • Speech and/or language
  • Motor
  • Brainstem
  • Retinal

Aura Characteristics (Need ≥3 of 6)

  • At least one aura symptom spreads gradually over ≥5 minutes
  • Two or more aura symptoms occur in succession
  • Each individual aura symptom lasts 5-60 minutes
  • At least one aura symptom is unilateral
  • At least one aura symptom is positive (e.g., scintillations, not just loss of function)
  • Aura is accompanied with or followed by headache within 60 minutes

Exclusion

  • Not better accounted for by another ICHD-3 diagnosis

Key Differentiating Feature

The gradual spread of aura symptoms over ≥5 minutes and their successive occurrence distinguishes migraine aura from transient ischemic attacks (TIA), which have sudden, simultaneous onset. 1

Chronic Migraine

Requires all of the following: 1

  • ≥15 headache days per month for >3 months
  • Patient has had at least 5 previous attacks meeting criteria for migraine without aura and/or migraine with aura
  • On ≥8 days per month for >3 months, headaches meet one of:
    • Criteria for migraine without aura (characteristics + associated symptoms)
    • Criteria for migraine with aura
    • Believed by patient to be migraine at onset AND relieved by triptan or ergot derivative
  • Not better accounted for by another ICHD-3 diagnosis

Clinical Pearls

Both migraine with aura and migraine without aura can coexist in the same patient—many individuals with migraine with aura also experience attacks without preceding aura. In such cases, diagnose both types. 1

When to Suspect Migraine

  • Migraine without aura: Recurrent moderate-to-severe headache, particularly if unilateral and/or pulsating, with photophobia, phonophobia, nausea, and/or vomiting 1
  • Migraine with aura: Above symptoms plus recurrent, short-lasting visual and/or hemisensory disturbances 1
  • Chronic migraine: ≥15 headache days per month 1

Supporting Features

  • Family history of migraine (strong genetic component) 1
  • Onset at or around puberty 1

Common Pitfall

Only 20% of patients who fulfill criteria for chronic migraine are actually diagnosed with the disorder—maintain high clinical suspicion when patients report frequent headaches. 2

Diagnostic Approach

Medical history is the mainstay of diagnosis. Physical examination is confirmatory. Neuroimaging and other investigations are only needed to exclude secondary causes when red flags are present. 1

References

1
Guideline

diagnosis and management of migraine in ten steps.

Nature Reviews Neurology, 2021

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.