Diagnosing Migraine

Reviewed by: HU Medical Review Board | Last reviewed: October 2020 | Last updated: March 2022

Doctors diagnose migraine by ruling out other conditions that cause similar symptoms. They also use standards set by the International Headache Society (IHS). For each type of migraine, IHS lists a set of specific symptoms and how often those symptoms occur.1

The International Headache Society names 2 main types of migraine, and each has several subtypes. Migraine types are diagnosed based on the symptoms a person has.

Using a migraine diary for diagnosis

When diagnosing migraine, your doctor will ask you a series of questions. Your answers will help your doctor build a detailed health history. Keeping a migraine diary (sometimes called a migraine journal) will help you and your doctor find answers.

A few of the questions your doctor may ask include:2

  • When did these attacks start?
  • What were you doing when the head pain started?
  • Do you have nausea, vomiting, or sensitivity to light and sound?
  • How often do you have these symptoms?
  • How intense are your symptoms?
  • How long do the symptoms last?
  • Is the head pain on 1 side or both sides of the head? Is the pain throbbing or a dull ache?
  • Do you have to stop normal activities like work, cooking, or walking?
  • Have you noticed a pattern to your attacks?
  • Can you tell if an attack is coming on because of vision changes, vertigo, or numbness?
  • What have you tried to make the pain better? What makes the pain better or worse?
  • Is there a family history of migraine or headaches?

You should also be prepared to talk about your lifestyle. Lifestyle issues that can impact migraine include diet, exercise habits, smoking, and whether you drink alcohol. They will also ask whether you have other conditions, such as depression, sleep apnea, or allergies. This information will also help your doctor build a treatment plan for you.2

Diagnosis of migraine without aura

Most people with migraine have migraine without aura. To be diagnosed with migraine without aura, you doctor will look for:1

  • At least 5 attacks
  • Head pain that lasts 4 hours to 3 days, if untreated
  • Head pain on 1 side of the head that feels throbbing or pulsing, is moderate to severe, and gets worse with routine activity such as walking or climbing stairs
  • Nausea, vomiting, or both
  • Sensitivity to light and sound

Diagnosis of migraine with aura

About 1 out of every 4 people with migraine will have migraine with aura. Aura is a group of temporary changes to vision, hearing, or touch that come with migraine head pain. To be diagnosed with migraine with aura, you doctor will look for the same symptoms as migraine without aura, plus:1

  • At least 2 attacks
  • Changes in sight, hearing, speech, movement, numbness, or tingling that spread over 5 minutes or longer
  • Aura symptoms that last 5 minutes to 1 hour and then wear off
  • Aura symptoms that begin up to 1 hour before the head pain or overlap with head pain

Tests to rule out other conditions

There are no blood or imaging tests to diagnose migraine. However, migraine symptoms can mimic some other serious health conditions such as brain tumor, stroke, or infection. This means your doctor may order any of these tests depending on your symptoms:3

  • MRI (magnetic resonance imaging)
  • CT scan (computed tomography)
  • Blood work
  • Urinalysis
  • X-ray
  • EEG (electroencephalogram)
  • Eye exam
  • Spinal tap/lumbar puncture

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