Migraine Diagnosis and Tests

How is Migraine diagnosed?

Migraine cannot be diagnosed clearly by neuroimaging yet. Neuroimaging, like MRI, is done to exclude other conditions associated with headache, like a blood clot in the brain. Migraine diagnosis is based on history taking.

The clinical criteria to confirm migraine are:

Migraine without aura

• At least 5 headache attacks (in 15 days or more per month for more than 3 months) fulfilling 2 to 4 of the criteria given below.
• Headache lasting 4 to 72 hours
• The headache has at least 2 of the following characteristics: one-sided location, pulsating quality, moderate to severe intensity or aggravated by or causing avoidance of routine physical activity.
• During the headache, at least one of the following occurs: nausea and/or vomiting, photophobia (sensitivity to light) or phonophobia (sensitivity to sound)
• The headache cannot be attributed to any other disorder

Migraine with aura

• At least 2 headache attacks fulfilling 2 to 4 of the criteria below.
• An aura consisting of at least one of the following: visual disturbances, tingling sensation or slurred speech. There will be no motor weakness and the symptoms will last only for about 2 mins.
• At least 2 of the following characteristics: (1) homonymous visual symptoms and/or unilateral sensory symptoms. This means the same part of the visual field is affected, for example, the right half of both eyes or left half of both eyes affected and/ or same side of the body will suffer from sensory symptoms like twitching or numbness (2) gradual development of at least one aura over 5 minutes or more and/or different aura symptoms occurring in succession over 5 minutes and more (3) each symptom lasts longer than 5 minutes but not longer than 60 minutes.
• The headache fulfils 2 to 4 of the following criteria:

1. Headache lasting 4 to 72 hours
2. The headache has at least 2 of the following characteristics: one-sided location, pulsating quality, moderate to severe intensity or aggravated by or causing avoidance of routine physical activity.
3. During the headache at least one of the following occurs: nausea and/or vomiting, photophobia     (sensitivity to light) or phonophobia (sensitivity to sound)
4. The headache cannot be attributed to any other disorder

Apart from patient history, the patient should maintain a pain diary in which he/she records the duration, intensity, features of headache and other associated symptoms.