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.


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.
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