How do physicians diagnose a migraine?

Answer 1

Doctors diagnose migraine by asking questions about your symptoms to find out if your experience 1) will fit the criteria needed for diagnosis of migraine 2) if your symptoms indicate there may be another cause for head pain and other symptoms.

Because Migraine is primary (not caused by something else) and a diagnosis of exclusion, sometimes MRI/MRA or CT scans are used so that the physician can see visually whether there may be a physical cause within the brain or brain's vascular system that may be triggering the pain.

Below are the criteria adopted by the International Headache Society for two main types of migraine headache - without aura and with aura. The criteria are used as a framework of the most predominant symptoms suffered by migraineurs. They do not describe the experience of every migraineur.

Diagnostic criteria for Migraine Without Aura:

1. Migraine without aura: at least 5 attacks fulfilling criteria B-D.
2. Headache attacks lasting 4-72 hours
3. Headache has at least two of the following characteristics:
   1. unilateral location
   2. pulsating/throbbing quality
   3. moderate or severe pain intensity
   4. aggravation by or causing avoidance of routine physical activity
4. During headache at least one of the following:
   1. nausea and/or vomiting
   2. sensitivity to light and/or sound
5. Not attributed to another disorder

Diagnostic criteria for *Typical Migraine With Aura:

1. At least 2 attacks fulfilling criteria B-D
2. Aura consisting of at least one of the following, but no motor weakness**:
   1. fully reversible visual symptoms including positive features (ie, flickering lights, spots or lines) and/or negative features (ie, loss of vision)
   2. fully reversible sensory symptoms including positive features (ie, pins and needles) and/or negative features (ie, numbness)
   3. fully reversible dysphasic speech disturbance (stuttering, slurring, or aphasia)
3. At least two of the following:
   1. Additional homonymous visual disturbance (which means a loss or blurring of visual in the same visual field in both eyes) and/or unilateral sensory symptoms (loss of sensation that occurs on one side of the body - such as numbness of the face or extremity)
   2. at least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes
   3. each symptom lasts ≥5 and ≤60 minutes***
4. Headache fulfilling criteria B-D for Migraine without aura begins during the aura or follows aura within 60 minutes
5. Not attributed to another disorder

*There are categories of atypical migraines. This diagnostic criteria only lists the most common and prominent features of the typical migraine with aura.

**Motor weakness associated with migraine (when no other physical cause is found) indicates atypical migraine, such as familial or sporadic hemiplegic migraine.

***In other types of migraine, aura may last longer than one hour, particularly in subtypes such as hemiplegic migraine where they may last a day or more. A rare complication of migraine is Persistent Aura without Infarction, which means that the aura phase may last for weeks, sometimes months or longer, but scanning of the brain do not indication that a stroke has occurred, meaning that damage to the brain is not At Fault for the neurological symptoms.