How Is Migraine Diagnosed?

Migraine is a disorder that often involves head pain. It may or may not include sensory disturbances, called auras. Migraine comes in episodes or attacks that can last anywhere from 4 to 72 hours if they are not treated. Head pain is one of the most frequent reasons someone goes to see a doctor. But not all head pain or headaches are migraine attacks.¹

How is a diagnosis made?

Migraine is a “diagnosis of exclusion.” This means that there is no one true way to diagnose migraine. Instead, your doctor will ask about your headache history. They may also order a list of other tests to make sure that your head pain is not something else.¹

If your headaches fit the description of migraine and all of those tests come back normal, then other diagnoses are considered “ruled out.” You can then officially be diagnosed with migraine.¹

What screening tools are used?

A screening tool is a set of questions that doctors use to narrow down what your symptoms may be. For your headaches to be considered migraine attacks you must experience 2 out of 3 of these things:¹

• Disability – Do your migraine attacks stop you from doing your daily activities? Do they keep you from work or school?
• Nausea
• Photophobia – Is it painful to be in bright rooms when you have a headache?

How is migraine “disability” assessed?

It may be difficult to explain to your doctors how your headaches affect your life. Keeping a headache journal may be very helpful to understand your triggers. It also can help you explain to your doctors what your head pain is like and how it affects you.²

What is the Headache Impact Test-6 (HIT-6)?

Your doctor may use a scoring system to better understand and treat your headaches. One widely used system is the Headache Impact Test-6 (HIT-6). The HIT-6 is made up of 6 questions. They ask how often, from "never" to "always," you experience certain problems because of headaches. Questions include:³

• When you have headaches, how often is the pain severe?
• When you have a headache, how often do you wish you could lie down?
• In the past 4 weeks, how often have you felt fed up or irritated because of your headaches?

What is the Migraine Disability Assessment Score (MIDAS)?

Another commonly used system is the Migraine Disability Assessment Score (MIDAS). The MIDAS questionnaire is made up of 5 questions. These questions ask you to count how many days in the past 3 months have been affected by a headache. It asks questions such as:⁴

• How many days have you missed work or school because of a migraine?
• How many days was your productivity affected?
• How many days did you miss activities that you enjoy?

Do your attacks fit the migraine definition?

If the screening tool indicates that you might have migraine, your doctor will ask you more questions to see if your headaches meet the migraine definition. The International Classification of Headache Disorders (ICHD) explains how to diagnose any type of headache. According to the ICHD, migraine should include these 4 characteristics:¹

• 5 or more migraine attacks in your lifetime
• Attacks that last 4 to 72 hours
• 2 or more of the following features: Pain on only one side of the head, pulsing or throbbing pain, moderate to severe pain, pain made worse by – or that makes it difficult to complete – normal activities
• 1 or more of the following: nausea, vomiting, pain that worsens with bright light, pain that worsens with loud noise

Your answers to your doctor's questions can help your doctor understand if your headaches are caused by migraine or by another disorder.¹

Which symptoms would require additional testing?

There are certain headache symptoms that are more concerning. These are things like a sudden “thunderclap” headache, fevers, or headaches that are worse when you move your head in certain ways. If you have these or other unusual symptoms, your doctor may want to order certain imaging tests like a computed tomography (CT) or magnetic resonance imaging (MRI) scan.^1,5

How are CTs and MRIs used?

The CT machine takes dozens of x-rays and combines them all to get a clearer image of your head, neck, and brain. The MRI machine creates a magnetic field to create a detailed image of your head, neck, and brain. These tests allow doctors to see brain bleeds, infections, tumors, brain damage, and other neurological (nervous system) conditions.⁵

If not migraine, then what?

There are multiple kinds of migraine. These include:¹

• Chronic migraine: more than 15 days out of every month are headache days
• Status migrainosus: a migraine that lasts more than 72 hours
• Migraine with aura
• Migraine without aura
• Migraine with brainstem aura: migraine symptoms plus other symptoms like dizziness, double vision, or being off balance
• Hemiplegic migraine: migraine symptoms plus muscle weakness on one side of the body and issues seeing or speaking
• Retinal migraine: migraine symptoms plus loss of vision in one eye

There are other headache disorders that are not migraine attacks. These include:¹

• Tension-type headaches
• Medication overuse headaches
• Cluster headaches

Many of those living with migraine attacks may not be diagnosed. Without a diagnosis, they may not be getting the care they need. If you believe that your headaches may be due to migraine, speak to your doctor.²