How Does a Doctor Diagnose a Migraine?
The guidelines and criteria that help doctors diagnose your migraine.
- Medical history provides the most complete “view” of your condition.
- The doctor may examine your head and neck.
- Doctors are also looking for any “red flag” symptoms that identify unusual headaches.
So you think you might suffer from migraines – what to do now? It might be time to go to the doctor. But that can understandably be intimidating or overwhelming. Here’s a quick overview of what to expect when visiting a doctor or neurologist to learn more about your migraines.
What Is a Migraine?
No single test can diagnose migraines. But The International Headache Society (IHS) publishes criteria for what a migraine is (and isn’t). For instance, the IHS describes migraines without aura as recurrent headaches that last up to 72 hours with characteristics like pain on one side of the head, a pulsating quality and moderate or severe pain intensity. Migraine symptoms may include nausea or photophobia (discomfort with bright lights). 1
Although more rare, migraines with aura have visual symptoms like geometric patterns, flashing lights or possibly a shimmering effect (kind of like heat waves) that indicate a migraine’s about to strike. Less than one quarter of migraine patients will experience aura, but those who do often start experiencing this visual impairment anywhere from five to 20 minutes before a migraine strikes.
Part 1: The Medical History
Although international guidelines help, MDs also rely on two sources of information to fill in the blanks on a migraine diagnosis: a physical exam and your medical history. According to Dr. Keri Peterson, of the two, your medical history provides the most complete “view” of your condition, helping your doctor sleuth, sift through, and rule out other diseases that could cause symptoms mimicking migraine. 2 3
So when you talk to your doctor, provide as many details as you can about your migraine symptoms, migraine history, other medical conditions, family history, and personal habits including diet and exercise. If this seems overwhelming, jot some notes down before your visit, or consider starting a migraine diary.
Dr. Peterson underscores the importance of a migraine diary: “It’s helpful for me to figure out if a patient needs preventative medication versus just acute management for a ‘now-and-then’ headache,” she says. Another important thing to think about? The medications you’ve tried. Dr. Peterson suggests bringing them in, too.
Part 2: The Medical Exam
As for the physical exam, the doctor may examine your head and neck and will usually do neurological exercises that test strength, reflexes, and sensation. Your doctors may also focus on your level of consciousness, coordination, and gait, and might test short-term memory. 4
Your doctor may ask you about the quality of your headache, how long your headaches last, whether you feel nauseous or are vomiting, if you have sensitivity to light and how disabled you might feel when you’ve got the headache – all are part of the guidelines used in a migraine diagnosis. 5
In particular, you may expect questions about the location of the pain. Dr. Peterson stresses that migraines are classically defined as throbbing pain on one side of the head for some. This detail gives doctors a huge clue to diagnosing a migraine.
Why all the questions? Migraines can be difficult to diagnose. Case in point: Migraines are often misdiagnosed as sinus headaches. Doctors are also looking for any “red flag” symptoms that identify unusual headaches like cluster headaches. 6
Some red flags include fever, weight loss, runny nose, eye tearing or sudden onset of headaches. Doctors use a method called SSNOOP to elicit whether any of these worrisome symptoms are occurring (see the American Headache Society for more on SSNOOP). Your physical exam will include vital signs and simple neurologic tests to help rule out those possibilities. 7 If your doctor’s findings fit the SSNOOP criteria, blood tests and/or imaging studies will be ordered to pinpoint the root cause.
But try not to worry too much about tests; Dr. Peterson says that imaging studies are only rarely needed.
1. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. Cephalalgia. 2004;24(suppl 1):1. [http://ihs-classification.org/en/]
2. Mueller LL. Diagnosing and Managing Migraine Headache. JAOA. 2007;107(11)Suppl 6:ES10-ES16. http://www.jaoa.org/content/107/suppl_6/ES10.full.pdf+html
3. Ebell MH. Diagnosis of Migraine Headache. Am Fam Physician. 2006;74(12):2087-2088. http://www.aafp.org/afp/2006/1215/p2087.html
4. Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disord. 2013;6(6):369-374.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825114/
5. Ebell MH. Diagnosis of Migraine Headache. Am Fam Physician. 2006;74(12):2087-2088. http://www.aafp.org/afp/2006/1215/p2087.html
6. Beck E. Hard-to-diagnose headache: Practical tips for diagnosis and treatment. Am Fam Physician. 2013;87(10):672-673.
7. Ertresvg JM, Stovner LJ, Kvavik LE, et al. Migraine aura or transient ischemic attacks? A five-year follow-up case-control study of women with transient central nervous system disorders in pregnancy. BMC Medicine 2007;5:19.
8. American Academy of Neurology. AAN Summary of Evidence-based Guideline for CLINICIANS. Migraine headache.https://www.aan.com/Guidelines/Home/GetGuidelineContent/120. Accessed June 4, 2014.