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Migraine Diagnosis

Diagnosing migraine

Migraine is considered a diagnosis of exclusion. That means in order to diagnose migraine, other possible causes of the symptoms must be ruled out or excluded. Therefore many people ask, can you diagnose migraines with certainty? Doctors have a range of criteria and tests for diagnosing migraine. Migraine diagnosis typically centers around a description of the different migraine symptoms, how long they occur and how long they last. That’s why it’s key to keep a record of your symptoms—their intensity and frequency—in your migraine symptoms journal. This will help your migraine specialist determine what tests to run to rule out other reasons for your discomfort.

Depending on your migraine symptoms, doctors may use a range of other tests before diagnosing your migraine attacks.

Some tests than can be conducted to exclude other causes of the attacks:

Commonly used guides for determining if a migraine is the culprit come from the International Headache Society.

Diagnosing migraine without aura

Patients have attacks that meet the following:
A. Patient experienced at least five attacks that meet the criteria, B through D, listed below
B. Headache lasting four to 72 hours (untreated or unsuccessfully treated)
C. Headache with at least two of the following four characteristics:

1. Unilateral location (pain on one side of the head)

2. Pulsating quality (head throbs)

3. Moderate or severe intensity (inhibits or prohibits daily activities).

4. Aggravation by or causing avoidance of routine physical activity, like walking up or down stairs or performing similar physical activity

D. During headache, at least 1 of the following must occur:

1. Nausea with or without vomiting

2. Photophobia (sensitivity to light) or phonophobia (sensitivity to sound)

E. Not better accounted for by another ICHD-III diagnosis

Diagnosing migraine with aura

Aura can cause visual symptoms as well as lead to disturbances in other senses. Patients have attacks that meet the following:
A. Patient experienced at least 2 attacks fulfilling criteria B and C, listed below
B. Headache with at one or more of the following four characteristics:

1. Visual

2. Sensory

3. Speech and/or language

4. Motor

5. Brainstem

6. Retinal

C. Headache with at least 2 of the following four characteristics:

1. At least one aura symptom spreads gradually over 5 or more minutes, and/or 2 or more symptoms occur in succession

2. Each individual aura symptom lasts 5-60 minutes

3. At least one aura symptom is unilateral

4. The aura is accompanied, or followed within 60 minutes, by headache

D. Not better accounted for by another ICHD-III diagnosis, and transient ischaemic attack has been excluded.

Visual aura symptoms include

  • Seeing flashes or flickering light
  • Seeing zigzag lines or waves, also called fortification illusions
  • Seeing spots, stars, halos, circles, lines, other shapes or colors
  • Blurry vision
  • Loss of vision
  • Cloudy vision
  • Other vision changes
  • Seeing three-dimensional effects
  • Seeing dark areas

Sensory aura can cause the following symptoms, in the face, tongue, hand, arm, foot, leg or throughout the body:

Diagnosing migraines can be tricky, particularly since there’s no specific blood or saliva test for it. Keeping a record of your symptoms and finding a doctor who specializing in treating migraines is the best course of action.


Written by: Otesa Miles | Revised by: Kristine Zerkowski | Last reviewed: August 2014.
  1. Guidelines for the diagnosis and management of migraine Canadian Med Assoc Pryse-Phillips 1997.
  2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808.