From the Guidelines
Laboratory tests are not routinely required for diagnosing acute migraine in patients with a typical presentation and normal neurological examination. However, certain lab tests may be considered in specific situations, such as when the headache presentation is atypical, when there are concerning neurological symptoms, or when secondary causes need to be ruled out. These tests may include:
- A complete blood count (CBC) to check for infections or anemia
- Basic metabolic panel to assess electrolyte imbalances
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to evaluate for inflammatory conditions
- Thyroid function tests to rule out thyroid disorders that can trigger headaches In some cases, cerebrospinal fluid analysis may be performed if meningitis or subarachnoid hemorrhage is suspected 1. These tests help differentiate migraine from secondary headache disorders that require different management approaches. The decision to order laboratory tests should be individualized based on the patient's clinical presentation, medical history, and the presence of any red flag symptoms such as sudden onset severe headache, fever, altered mental status, or focal neurological deficits.
The diagnosis of migraine is primarily based on the medical history, with the assistance of published diagnostic aids, and physical examination is most often confirmatory 2. Further investigations, such as neuroimaging, blood samples, or lumbar puncture, are occasionally required to confirm or reject suspicions of secondary causes for headache. The International Headache Society's diagnostic criteria for migraine should be applied systematically to enable accurate diagnosis 3.
It is essential to consider differential diagnoses, including other primary headache disorders, such as tension-type headache and cluster headache, and secondary headache disorders, such as medication-overuse headache 4. Red flags in the medical history, such as thunderclap headache, atypical aura, and head trauma, and red flags in the physical examination, such as unexplained fever, impaired memory, and focal neurological symptoms, should create suspicion and prompt further investigation.
In summary, while laboratory tests are not routinely required for diagnosing acute migraine, they may be necessary in specific situations to rule out secondary causes or to evaluate for underlying conditions that may be contributing to the headache. The decision to order laboratory tests should be individualized and based on the patient's clinical presentation and medical history.
From the Research
Laboratory Tests for Acute Migraine
There are no specific laboratory tests indicated for acute migraine (headache) diagnosis. However, the following points highlight the treatment and management of acute migraine:
- Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 5.
- Patients not responsive to these treatments may require migraine-specific treatments including triptans (5-HT1B/D agonists) 5.
- Some key considerations for choosing an acute migraine medication include:
- Available acute medications can be organized into different treatment strategies, including:
- A strategy for attacks of mild to moderate severity (e.g., acetaminophen and/or NSAIDs)
- A triptan strategy for patients with severe attacks and for attacks not responding to the first strategy
- A refractory attack strategy
- A strategy for patients with contraindications to vasoconstricting drugs 6
- The administration of acute medications should follow the concept of "stratified care" 8.
- Some medications, such as opioids, are not recommended for acute migraine treatment due to serious adverse events 8, 5.