HOW DOES A MIGRAINE DIAGNOSIS WORK?
When it comes to how to diagnose migraine from head pain symptoms, your physician will likely follow these guidelines and criteria.
Your head is pounding, your stomach is churning, and every whisper sounds like a shout. You think you might be suffering from migraines, but the idea of talking with a doctor somehow feels intimidating. How will your doctor be able to determine whether your head pain is migraine-related? Here’s a quick overview of what to expect when visiting a doctor or neurologist for a potential migraine or chronic migraine diagnosis.
No single test can give a migraine diagnosis, 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 recurring headaches that last up to 72 hours, with symptoms including 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 or sensitivity to bright light).1
Although they’re less common, migraines with aura have visual symptoms like seeing geometric patterns, flashing lights or possibly a shimmering effect (kind of like heat waves) prior to a migraine striking. Less than one quarter of migraine patients will experience aura. Those who do often have visual impairment starting 5-60 minutes before a migraine strikes.1
Part 1: The Medical History
Doctors rely on two sources of information to fill in the blanks during a migraine diagnosis: your medical history and a physical exam. Your medical history provides the most complete view of your condition, says Elizabeth Seng, Ph.D., a clinical psychologist and headache researcher in New York City. It helps your doctor to sift through and rule out other diseases with symptoms that may mimick a migraine.2
When you talk to your doctor, you’ll be asked to provide as many details as you can about your symptoms, other medical conditions, family health issues, and your head pain history. “We want to know anything that’s ever happened with your brain,” says Dr. Seng.
You’ll also be asked about your personal habits – including diet and exercise, or your average levels of stress – and may be requested to keep a migraine diary for one month. During this time, you’ll write down every time you have head pain and what it feels like, says Dr. Seng. For example, is the pain pulsing or pressing? On just one side of your head or both? Where does the pain start, and how severe is it on a scale of 1 to 10? Does your pain get worse with exercise?
“This diary is really going to tell the doctor everything he or she needs,” says Dr. Seng. “When diagnosing migraines, we look for two of these four symptoms: severity, pounding or pulsing quality, one-sided pain, and pain that gets worse with physical activity.”2
Part 2: The Medical Exam
For the physical exam, the doctor may check your head, shoulders and neck, and will usually do neurological exercises that test strength, reflexes and sensation. You might also be tested for symptoms such as alertness, coordination, and gait, as well as short-term memory.3
Your doctor will likely ask you how long your headaches last, whether you feel nauseous or are vomiting, if you have sensitivity to light, and how much your headache affects your mobility or how you’re able to get on with your day. These are all part of the guidelines for a migraine diagnosis.1 In particular, expect questions about the location of the pain, since many times migraines involve throbbing pain on one side of the head.
A Process of Elimination
Why all the questions? Doctor want to rule out other types of head pain, such as sinus headaches and cluster headaches, as well as other potential causes. Red flags that something else is going on include fever, weight loss, runny nose, eye tearing or sudden onset of headaches.
Doctors use a method called ‘SNOOP ‘to elicit whether any of these worrisome symptoms could be a sign of a more serious health situation, such as a brain aneurysm or brain tumors (see the American Headache Society for more information). Your physical exam will include vital signs and simple neurologic tests to help rule out those possibilities. In the rare case that your doctor finds cause for concern, blood tests and/or imaging studies will be ordered to pinpoint the root cause, says Dr. Seng.
With a diagnosis in hand, your doctor can help you come up with a treatment program best suited to your needs. Treatments for migraine vary widely, according to migraine symptoms, frequency and severity as well as coexisting medical conditions.4 Your solution will likely involve some form of medication, either in prescription or over-the-counter form, such as Excedrin Migraine, along with adjustments to your daily routine and lifestyle.
Discover the full Excedrin product range for headache pain relief – including migraine, night-time and tension headaches.
1. “Migraine.” ICHD-3 Beta The International Classification of Headache Disorders 3rd Edition (Beta Version), www.ichd-3.org/1-migraine/. Access date: 5 October 2017.
2. “Migraine.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 Apr. 2017, www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207.
3. “Migraine Headaches.” University of Maryland Medical Center, www.umm.edu/health/medical/reports/articles/migraine-headaches.
4. “Migraine Headache.” AAN Summary of Evidence-Based Guideline for CLINICIANS, 2009, www.aan.com/Guidelines/Home/GetGuidelineContent/120.