From the Guidelines
Nausea or vomiting (option b) is most helpful in diagnosing chronic migraine. Chronic migraine is defined as headaches occurring on 15 or more days per month for more than three months, with at least eight of those headache days having migraine features. Nausea or vomiting is one of the key diagnostic criteria for migraine according to the International Classification of Headache Disorders. These symptoms are highly specific to migraine and help differentiate it from other headache disorders. While double vision is not a typical migraine symptom and may suggest other neurological conditions, and bilateral headache can occur in various headache disorders including tension-type headaches, the presence of nausea or vomiting strongly supports a migraine diagnosis. The pathophysiology involves activation of the trigeminovascular system and brainstem nuclei that control nausea and vomiting during migraine attacks. When evaluating patients with frequent headaches, the presence of associated nausea or vomiting provides strong evidence for a migraine diagnosis rather than other chronic headache conditions 1.
Some key points to consider when diagnosing chronic migraine include:
- A patient experiencing 15 or more headaches per month, each at least 4 hours in duration, with headaches on 8 or more days each month associated with migraine features, with or without medication use 1
- The use of a headache diary to track the number of headaches per month, as patients may not be able to report this information accurately without a record 1
- The importance of asking patients about their symptoms, including nausea or vomiting, to help differentiate migraine from other headache disorders 1
It is also important to note that the diagnosis of chronic migraine can be challenging, and a thorough evaluation is necessary to rule out other potential causes of headache 1. However, the presence of nausea or vomiting is a key factor in supporting a diagnosis of chronic migraine.
From the Research
Diagnostic Criteria for Chronic Migraine
The diagnosis of chronic migraine requires a systematic approach, including excluding secondary headache disorders and diagnosing a specific primary headache syndrome based on frequency and duration 2. According to the revised 2nd Edition of the International Classification of Headache Disorders, chronic migraine is defined as headaches occurring on ≥15 days per month for ≥3 months, of which headaches on ≥8 days must fulfill the criteria for migraine without aura 3.
Symptoms of Chronic Migraine
Chronic migraine is characterized by frequent headaches, hypersensitivity to visual, auditory, and olfactory stimuli, nausea, and vomiting 4. The symptoms of chronic migraine can be severe and disabling, affecting not only the patient but also their family and society as a whole.
Helpful Diagnostic Factors
Considering the options provided:
- Double vision is not a specific diagnostic criterion for chronic migraine.
- Nausea or vomiting is a common symptom of migraine, including chronic migraine, and can be helpful in diagnosing the condition.
- Bilateral headache is not a specific diagnostic criterion for chronic migraine, as migraine headaches can be unilateral or bilateral.
Based on the evidence, nausea or vomiting (option b) is the most helpful symptom in diagnosing chronic migraine, as it is a common associated symptom of the condition 4, 5. However, it is essential to note that a careful patient interview, neurologic examination, and additional diagnostic tests may be necessary to differentiate chronic migraine from secondary headache disorders and other primary chronic headaches of long duration 4.