How Migraine is Diagnosed

To diagnose migraine a high index of suspicion is required at the beginning. There are certain characteristic clinical features in migraine headache. In migraine there is an aura (the migraine aura), which makes the patient understand the disease. The migraine aura, consist of visual disturbances with flashing lights or zigzag lines moving across the visual field or sometimes certain neurological symptoms.

The simplified diagnostic criteria for migraine are given below:

Repeated attacks of headache which lasts for 4 to 72 hours in patients with a normal physical examination, no other reasonable cause for the headache is the most important feature of migraine headache and along with this there should be at least 2 out of 4 major symptoms and 1 out of 2 minor symptoms of migraine. Vertigo is a fairly common problem with migraine and approximately one-third of patients with vertigo or dizziness have a primary diagnosis of migraine.

The four major symptoms of migraine headache are unilateral pain, throbbing pain, aggravation by movement and moderate to severe intensity pain. At least 2 out of these four symptoms should be present to diagnose migraine.

The two minor symptoms of migraine headache are nausea/vomiting and photophobia and/or phonophobia (fear of noise). At least 1 out of the two minor symptoms should be present to diagnose migraine headache.

Patient of migraine should maintain a headache diary and it is very helpful sometimes in making the diagnosis as well as in assessing disability and the frequency of treatment for acute attacks. Patients with episodes of migraine that occur daily or almost daily have chronic migraine. Migraine must be differentiated from tension-type headache (TTH) which is the most common primary headache syndrome seen in clinical practice. If the headache is disabling type, most likely diagnosis is migraine.