From the Guidelines
Migraine diagnosis is primarily based on clinical features, including recurrent headache attacks lasting 4-72 hours, unilateral location, pulsating quality, moderate or severe pain intensity, and aggravation by routine physical activity.
Diagnostic Criteria
The diagnostic criteria for migraine can be broken down into several key components:
- Migraine without aura: characterized by recurrent headache attacks that last 4–72 h, with typical features including a unilateral location, pulsating quality, moderate or severe pain intensity, and aggravation by routine physical activity, as well as associated symptoms such as photophobia, phonophobia, nausea, and vomiting 1.
- Chronic migraine: defined as headache (migraine-like or tension-type-like) on ≥15 days/month for >3 months, with attacks occurring in an individual who has had at least five attacks that fulfil the criteria for migraine without aura and/or for migraine with aura 1.
Recommendations
When suspecting migraine, consider the following:
- Recurrent moderate to severe headache, particularly if pain is unilateral and/or pulsating, and when the person has accompanying symptoms such as photophobia, phonophobia, nausea and/or vomiting 1.
- A family history of migraine and onset of symptoms at or around puberty can strengthen the suspicion of migraine 1.
Diagnostic Guidelines
The International Headache Society (IHS) criteria prioritize specificity over sensitivity, with an additional set of criteria for a diagnosis of probable migraine, which is defined as “migraine-like attacks missing one of the features required to fulfil all criteria for a type or subtype of migraine” 1. The IHS classification system serves to diagnose headache syndromes, not patients, and one patient could have more than one type of headache disorder 1.
From the Research
Diagnostic Criteria for Migraine
The diagnostic criteria for migraine have evolved over time, with various studies proposing different criteria for diagnosis. Some of the key criteria include:
- Unilateral site of pain
- Throbbing quality of pain
- Nausea
- Photophobia or phonophobia 2
- Moderate or severe intensity of pain headache
- Duration of pain, with a proposed lower limit of 1 hour 3
- Presence of aura, which can include symptoms such as visual disturbances, sensory changes, or speech and language problems
International Classification of Headache Disorders (ICHD) Criteria
The ICHD criteria are widely used for the diagnosis of migraine and other headache disorders. These criteria include:
- Migraine without aura: characterized by recurrent episodes of headache with specific features such as unilateral location, throbbing quality, and associated symptoms like nausea and photophobia 4, 5
- Migraine with aura: characterized by recurrent episodes of headache with aura symptoms, such as visual disturbances or sensory changes
- Probable migraine: a diagnosis given when some but not all features of migraine are met 4
Limitations and Proposed Modifications
Some studies have suggested that the current diagnostic criteria for migraine may not be sufficient, particularly in certain populations such as adolescents 3. Proposed modifications include:
- Allowing for a broader range of symptoms to be considered in the diagnosis of migraine, such as lightheadedness or spinning 4
- Dividing episodic and chronic migraine into subtypes based on frequency 6
- Refining the diagnostic criteria for specific types of migraine, such as aura, vestibular migraine, and hemiplegic migraine 6