From the Guidelines
Diagnosis of migraine headaches is primarily clinical, based on a detailed medical history, symptom evaluation, and physical examination, as outlined in the most recent guidelines from 2021 1. The diagnostic process involves recording medical history, applying diagnostic criteria, considering differential diagnoses, examining the patient to exclude other causes, and using neuroimaging only when a secondary headache disorder is suspected, as recommended in a 2021 study published in Nature Reviews Neurology 1. Key features to assess include:
- Frequency, duration, intensity, location, triggers, and associated symptoms like nausea, vomiting, or sensitivity to light and sound
- The International Headache Society criteria, which require at least five attacks lasting 4-72 hours with at least two specific features, such as unilateral location, pulsating quality, moderate to severe intensity, and aggravation by routine physical activity
- Either nausea/vomiting or both photophobia and phonophobia must be present Neuroimaging tests like MRI or CT scans may be ordered to rule out other conditions but don't diagnose migraines themselves, as stated in a 2002 study published in American Family Physician 1. Additionally, a headache diary tracking frequency, duration, severity, triggers, and response to medications can be valuable for diagnosis and treatment planning, as suggested in a 2015 study published in Mayo Clinic Proceedings 1. In some cases, a doctor might recommend a trial of migraine-specific medication; a positive response can support the diagnosis. It's essential to note that the diagnosis and management of migraine should be patient-centric, with a focus on patient education and treatment adherence, as emphasized in the 2021 Consensus Statement endorsed by the European Headache Federation and the European Academy of Neurology 1.
From the Research
Diagnostic Tests for Migraine Headaches
The diagnostic tests for migraine headaches are primarily based on a thorough medical history, physical examination, and the presence of specific symptoms. The following are some of the key points to consider:
- A systematic diagnostic approach is essential to accurately diagnose migraine headaches, as the clinical features of migraine can overlap with secondary causes of headache 2.
- Neuroimaging tests such as MRI or CT scans may be considered in certain cases, such as when there are atypical features or red flags present, but are not necessary for patients with typical migraine symptoms and a normal neurologic examination 3.
- A stepwise diagnostic approach to migraine involves taking a thorough headache history, excluding secondary headache, and identifying primary headache disorder using screening tools or ICHD-3 criteria 4.
- The diagnosis of migraine can be supported by the presence of specific symptoms, such as episodic, disabling headache, and the absence of contradictory evidence 5.
Diagnostic Criteria
The diagnostic criteria for migraine headaches include:
- A thorough medical history to identify patterns and characteristics of the headache 2.
- A physical examination to rule out secondary causes of headache 2.
- The presence of specific symptoms, such as aura, frequency, and severity of headaches 3, 4.
- The use of screening tools or ICHD-3 criteria to identify primary headache disorder 4.
Neuroimaging Tests
Neuroimaging tests such as MRI or CT scans may be considered in certain cases, including:
- Unusual, prolonged, or persistent aura 3.
- Increasing frequency, severity, or change in clinical features 3.
- First or worst migraine 3.
- Migraine with brainstem aura, migraine with confusion, or migraine with motor manifestations (hemiplegic migraine) 3.
- Late-life migraine accompaniments, aura without headache, side-locked headache, or posttraumatic headache 3.