Diagnosing Migraine

Please note, since the publication of this article, the guidelines for migraine diagnosis have been updated. For information on the most current, ICHD-III, guidelines please click here.

There is no test to definitively diagnose Migraine. Migraine is partly a diagnosis of exclusion, which means it’s diagnosed by excluding other diagnoses. It’s also partly diagnosed by reviewing family medical history because Migraine has been found to have a genetic component. The other part is using the International Headache Society’s International Classification of Headache Disorders, 2nd Edition (ICHD-II). Migraine is diagnosed by:

  • Reviewing our medical history.
  • Reviewing our family medical history. Since Migraine has been found to have a genetic component, it can be important to know our family medical history. Keep in mind that we can have people in our families who had Migraines, but didn’t realize it, or didn’t call them Migraines. For example: My grandmother had what were undoubtedly Migraines, but she always called them her “sick headaches.” My father would be in bed for days with what he thought were sinus headaches. We now know that sinus headaches are rare without infection, and that most of what people think are sinus headaches are really Migraines.
  • Discussing our symptoms with us.
  • Conducting a thorough physical examination.
  • Ruling out other causes for our symptoms.
  • Using the ICHD-II to determine if our symptoms fit Migraine and, if so, which form of Migraine.

Testing:

When a diagnosis of Migraine is clear-cut — there’s a family history of Migraine, the symptoms clearly fit Migraine — doctors may not order any diagnostic testing. If, for some reason, the diagnosis isn’t so clear, tests may be ordered — not to diagnose Migraine, but to rule out other possible causes of the symptoms. The most commonly ordered diagnostic tests are CT scans and MRIs.

Diagnosis, A Team Effort:

Since there’s no test our doctors can order that will come back and say, “This patient has Migraines,” the diagnostic process goes more smoothly and quickly when we participate as fully as possible. There are several ways we can prepare for our appointments that will help our doctor with diagnosis:

  • Keep a Migraine journal detailing when we have Migraines, our triggers, the medications we take, and other details.
  • Along with that journal, keep detailed notes about our symptoms.
  • Make notes about any family history of Migraine or headache. If we don’t know about family history, find someone in the family to ask.

An Accurate Diagnosis Is Essential:

An accurate diagnosis is essential to proper treatment and our having as good a quality of life as possible. Unfortunately, not every doctor is equipped to make an accurate diagnosis. A 2011 report from the WHO disclosed:

“Lack of knowledge among health-care providers is the principal clinical barrier to effective headache management. This problem begins in medical schools where there is limited teaching on the subject, a consequence of the low priority accorded to it… Worldwide, formal undergraduate medical training included just four hours about headache and Migraine; specialist (neurologist) training included 10 hours.”2

During a recent episode of The Diane Rehm Show on NPR, Dr. David Dodick, Migraine specialist, director of the headache center at the Mayo Clinic in Scottsdale, Arizona, and past president of the American Headache Society, stated that he received NO undergraduate medical training on Migraine or headache.3

If a doctor gives us a diagnosis of “Migraine,” but not a more specific diagnosis, that’s not a complete diagnosis. In that type of situation, or if we’re not confident in the diagnosis we’re given, there’s nothing wrong with getting a second opinion. It’s our body, our health; and the person with the most at stake gets to be in charge.

Wrapping It Up:

Getting an accurate diagnosis is essential. Diagnosing Migraine is partly looking at our medical history and family medical history, partly ruling out other diagnoses, and partly using the ICHD-II. We need to do our part in providing our doctors with as much information as possible. If, armed with that information, our doctors don’t provide a full diagnosis, or we’re not confident in that diagnosis, it’s time for a second opinion. With a solid diagnosis, we can get the treatment we need to take care of ourselves and live as well as possible despite this disease.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
1Rizzoli, Paul, MD, FAAN; Loder, Elizabeth, MD, MPH; Neporent, Liz. the migraine solution. New York. St. Martin’s Griffin. • 2World Health Organization, Lifting the Burden. “Atlas of Headache Disorders and Resources in the World 2011.” Geneva. WorldHealth Organization. May, 2011. • 3The Diane Rehm Show. “Living With Migraine And the Search For New Treatments.” WAMU 88.5 NPR. Washington, DC. August 16, 2012.

Comments

View Comments (7)
  • jamesbogash
    6 years ago

    Two comments…First, a big mistake I see in diagnosis is the unilateral vs bilateral. Migraine, by definition is unilateral in nature. It may switch from side to side from episode to episode, however. Second, there have been numerous studies finding higher levels of palpatory pain in the cervical musculature in migraineurs. This likely represents some crossing over between categories of headaches, but it still indicates that you can NOT make a diagnosis of any type of headache without palpating the soft tissues of the neck.

  • Teri-Robert author
    6 years ago

    James,

    We follow the International Headache Society’s International Classification of Headache Disorders, 2nd edition (ICHD-II). Migraine does not have to be unilateral. According to the ICHD-II a Migraine must have:

      C – Head pain that has at least two of the following
    • Pain on one side of the head, unilateral pain
    • Pulsating or throbbing pain
    • Moderate to severe head pain
    • Triggered by routine physical activity, such as walking or climbing stairs

    In “Headache in Clinical Practice,” Silberstein et. al. say the pain is bilateral at onset in 40% of cases or start on one side and become generalized.

  • mrsbrimtown
    7 years ago

    What other diagnoses need to be excluded? Does anyone know the most common ones that need to be excluded first?

  • Teri-Robert author
    7 years ago

    There are several other conditions with similar symptoms including multiple sclerosis, stroke, TIA, brain tumor, and aneurysm.

  • karenmullins
    7 years ago

    Awesome advise. The more info your doc has the faster the diagnosis.

    I am currently finding that nightshade vegetables trigger migraines.

    Has anyone had success with elimating tomatoes, white potatoes, peppers, etc.?

  • 7 years ago

    What Dr. Dodick said was absolutely right on the money. During my residency training which was not as long ago as David’s, there were 15 neurologists and not one really knew much about treatment. That’s why I went to a fellowship to learn all about it. I am very thankful for that extra training.

    Why is it that many docs don’t know much, even neurologists? I think a lot of it is knowledge that is “passed down” from older physicians (especially in the ER) without interest in treating migraine because there are no tests and docs have to talk to patients.

  • Ellen Schnakenberg
    7 years ago

    *OUCH*. Thanks for telling it like it is Dr Whyte. :). Honesty and openness can be so very refreshing to some of us as patients. 🙂

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