Take A Detailed History
Accurate history taking is vitally important in the diagnosis of migraine. It is important to give patients time to describe their attacks fully , and also to clarify the history with specific questions aimed at filling out the gaps in what the patient has told you spontaneously. The diagnosis of migraine lies in the history, and that the purpose of examination is primarily to look for other problems that may be exacerbating an underlying tendency to migraine. This may in most cases be restricted to fundoscopy, inspection and palpation of the head and neck structures, and a brief screening cardiovascular and neurological examination, unless, on the basis of the history, serious intracranial or systemic pathology is suspected.
It is then useful to ascertain what treatments, current and previous, have been tried, and at what point these treatments are taken. Patients should be asked to bring a list of medications tried in the past, including doses, and be asked why these treatments were abandoned . The use of alternative or complementary therapies should also be sought.
While superficially there seems to be a lot of information required, it is almost invariably the case that patients will volunteer much of this information without being specifically asked, and it usually does not take too much time to fill out the gaps if a structured approach to the history taking is followed. If there is uncertainty, then encouraging the patient to keep a headache diary can be very useful.
What Are The Steps Of Migraine Diagnosis
The steps of migraine diagnosis will depend on your overall health, family history, and a few other factors.
You can start by seeing a primary care doctor. In some cases, you might need to see a neurologist for further testing and treatment. During your migraine diagnosis, a doctor will:
- gather your medical history
- order scans to rule out other conditions
You can read more about each step below.
Who Is At Risk For Migraines
About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you
- Are a woman. Women are three times more likely than men to get migraines.
- Have a family history of migraines. Most people with migraines have family members who have migraines.
- Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.
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Ordering Scans To Rule Out Other Conditions
If your pain came on suddenly or if youre having other symptoms that arent typically caused by migraine, your doctor might order more testing.
- Magnetic resonance imaging . An MRI uses magnetic waves to create a detailed image of your brain. The MRI will look for infections tumors, bleeding, and other abnormalities in your brain that could be causing your head pain.
- Computed tomography . A CT scan creates a detailed image of your brain. Just like an MRI, a CT scan can be used to look for medical problems that could be the source of your pain.
Your doctor might also order blood work to help pinpoint other conditions that might be behind your pain and symptoms.
Keep in mind that these tests are for identifying causes that arent migraine. However, if no infections, tumors, or other possible causes are found, those causes can be ruled out. Ruling out other causes can allow your doctor to make a migraine diagnosis.
What Tests Can I Get Done To Detect If I Have Migraines
- A magnetic resonance imaging test. This allows the doctor to look at the soft tissues of the brain and to rule out dementia, nerve problems and tumors. The MRI, which uses a strong magnetic field, reads pulses coming from the tissues in your brain. During the MRI, you will lie on a table and be moved into a big tube, which makes thrumming sounds. The test allows doctors to see a detailed, 3-D view of your brain’s tissues. The test can take 20 to 45 minutes and can be uncomfortable for people who are claustrophobic .
- A computerized tomography scan. A CT scan is done to rule out cancerous tissues or blood clots. CT scans produce very detailed views. While most x-rays use a single ray, CT scans use many rays from different angles to achieve a 3-D image of your head. A doctor sometimes will inject a contrast dye into your veins to provide a better look at your brain. The test typically takes about 15 minutes.
- Spinal tap. A spinal test tests for serious brain diseases such as encephalitis and bacterial meningitis. It also can check for multiple scleroses and certain cancers. When a spinal tap is done, the doctor gives you something to numb your spine, then uses a long needle to pierce the base of your spine and collects some fluid there. The cerebrospinal fluid protects your spine and brain from getting hurt.
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Tests That May Be Used To Rule Out Other Diseases
Blood tests Blood tests can be done to rule out some other diseases that can cause headache.
Computerized tomography scan
Magnetic resonance imaging Similar to a CT scan, an MRI can also produce detailed images of your brain and blood vessels to help your doctor diagnose any tumors, strokes, bleeding, infections, or other neurological conditions that may be causing symptoms.
Lumbar puncture If your doctor suspects that your symptoms may be caused by an infection or neurological damage, you may be asked to undergo this procedure . In a lumbar puncture, your doctor will first sterilize the skin overlying two vertebrae , then anesthetize the area with an injection of a local anesthetic. After that, the doctor will insert a thin needle into the space between the vertebrae to remove a sample of cerebrospinal fluid for laboratory analysis.
How Is Abdominal Migraine Diagnosed
There is currently no test to confirm abdominal migraine. Your doctor will make a diagnosis based on specific criteria that details the type, frequency, and severity of symptoms associated with abdominal migraine. The diagnosis will typically be made only after all other causes of abdominal pain have been ruled out.
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How To Treat Migraine And Headaches
There are a variety of ways to help reduce or prevent headache symptoms. The first step is to find a doctor who can diagnose what type of headache you have just seeing your primary doctor is not likely to get you the diagnosis or treatment you need. Instead seek out a neurologist or headache specialist. The Migraine Research Foundation provides a list of headache doctors by state and city.
To diagnose your headache, you will probably be asked to fill out a detailed medical history and undergo a physical exam that will include testing your motor skills, senses, and reflexes. To rule out any possible serious conditions that may be causing your headaches, you also may be asked to undergo blood tests and imaging such as an MRI or CAT scan.
Once the diagnosis is made, your doctor will recommend a treatment approach based on the type of headache you have and the severity of your symptoms. The most common approaches include medications and making lifestyle changes, such as avoiding your known triggers and reducing stress.
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How Severe Or Frequent Should My Headaches Be Before I Seek A Diagnosis
For people who experience migraine once or twice a month and are able to manage it with an over-the-counter medication such as ibuprofen, its really up to the individual if they want to seek further treatment, says Sandhya Kumar, MD, a neurologist and headache specialist at Wake Forest Baptist Health in Winston-Salem, North Carolina.
If you have headaches more than four times a month and theyre impacting your quality of life, you should consider seeking a diagnosis and further treatment that is specific for migraine, she says.
Even for people who have more infrequent attacks, say once or twice a month, but they are debilitating, and they have to take the whole day off work or stay in bed all day, that person should seek a diagnosis and medical treatment for migraine, says Dr. Kumar.
We have a lot of medications we can use not only rescue medications when they have a headache, but also preventive medications to decrease the severity and frequency of their headaches, she adds.
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Can Chronic Migraine Be Prevented
Keep a daily headache diary. As soon as you notice an increase in the number of headaches you are having, see your headache specialist. Do not wait until your headaches become a daily occurrence to seek help. It is easier to halt and reverse chronic migraine if caught early.
Look at the risk factors and modify those you can .
What Are The Four Stages Or Phases Of A Migraine Whats The Timeline
The four stages in chronological order are the prodrome , aura, headache and postdrome. About 30% of people experience symptoms before their headache starts.
The phases are:
It can take about eight to 72 hours to go through the four stages.
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What Is A Migraine
No single test can diagnose migraines. But The International Headache Society publishes criteria for what a migraine is . For instance, the IHS describes migraines without aura as recurring 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 .1
Although theyre less common, migraines with aura have visual symptoms like seeing geometric patterns, flashing lights or possibly a shimmering effect prior to a migraine striking. Less than one quarter of migraine patients will experience aura. Those who do often have visual impairment starting five to 60 minutes before a migraine strikes.1
Whats A Migraine Journal
- Keeping a migraine journal is not only beneficial to you, but it helps your healthcare provider with the diagnosis process. Your journal should be detailed and updated as much as possible before, during and after a migraine attack. Consider keeping track of the following:
- The date and time of when the migraine began specifically when the prodrome started, if youre able to tell its happening. Track time passing. When did the aura phase begin? The headache? The postdrome? Do your best to tell what stage youre in and how long it lasts. If theres a pattern, that may help you anticipate what will happen in the future.
- What are your symptoms? Be specific.
- Note how many hours of sleep you got the night before it happened and your stress level. Whats causing your stress?
- Note the weather.
- Log your food and water intake. Did you eat something that triggered the migraine? Did you miss a meal?
- Describe the type of pain and rate it on a one to 10 scale with 10 being the worst pain youve ever experienced.
- Where is the pain located? One side of your head? Your jaw? Your eye?
- List all of the medications you took. This includes any daily prescriptions, any supplements and any pain medication you took.
- How did you try to treat your migraine, and did it work? What medicine did you take, at what dosage, at what time?
- Consider other triggers. Maybe you played basketball in the sunlight? Maybe you watched a movie that had flashing lights? If youre a woman, are you on your period?
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Do I Need A Formal Diagnosis Of Migraine To Receive Treatment
If you meet most, but not all, of the ICHD criteria, your doctor may diagnose you with probable migraine, according to the American Headache Society. You may be asked to continue to track your symptoms and the frequency and severity of your headaches to receive a formal diagnosis of migraine.
In the meantime, depending on which symptoms you have, your care provider will develop a treatment plan for how best to manage your attacks.
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 serious health situation such as a brain aneurysm or brain tumors . 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.
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What Is Migraine Surgery
Migraine surgery is a procedure designed to reduce and prevent migraines. New studies have shown that many migraines are initiated by irritation of nerves in the head and neck outside of the brain, also called peripheral neuralgias. Migraine surgery involves reducing this inflammation by decreasing pressure from surrounding structures, such as muscles and blood vessels, and decompressing the nerves that have shown to trigger headache symptoms.
This treatment is a breakthrough therapy that has significantly improved migraine symptoms for approximately 90 percent of patients treated. Depending on the severity of your condition, migraine surgery may either result in a complete disappearance of symptoms or a significant reduction in pain and discomfort associated with headaches. For many patients, the benefits of this surgery have proven immeasurable, having included increased productivity, decreased sensitivity to light and sound, and easier and more comfortable social interaction. Even for patients with less than perfect results gain the ability to rejoin life and spend more time with loved ones.
Our migraine quiz is the first step to helping patients understand more about their symptoms and whether migraine surgery is a suitable option. Take the quiz today to determine if you are a candidate!
How To Prepare For A Doctor Appointment To Discuss Potential Migraine Symptoms
- Make a complete list of your symptoms, including those that precede or follow a headache. Be sure to note whether you have nausea or sensitivity to light, sound, smell, or touch, but dont leave out other symptoms because you think theyre unrelated.
- Pay attention to what your headache feels like, what kind of pain youre experiencing, and where the pain is located.
- Note when your symptoms occur and how long they last.
- Note whether anything relieves your symptoms, and what that is.
- Tell your doctor whether youve noticed any patterns in your attacks, such as occurrence after a weather change, lack of sleep, or consumption of certain foods or drinks.
- Find out about your family history most people with migraine have a relative with migraine, even if that person was never formally diagnosed. Ask whether any relatives have bad headaches that cause them to spend the day in a dark room, or other symptoms typically associated with migraine.
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Who Is At Risk For Abdominal Migraine
Abdominal migraines mostly affect children, with the first episode occurring between 3 and 10 years old. Most children seem to outgrow the condition, though abdominal migraines in adulthood are just starting to be studied. A child with a family or personal history of migraine headache has an increased chance of developing abdominal migraine.
The American Migraine Foundations Guide To Triggers & How To Manage Them
The sudden onset of a migraine means a dark room, bed and a cool towel for most of us. While these seem to come out of nowhere, many will find that there are usually some signs that a migraine attack is on its way. These signs can reveal a pattern in your symptoms, and even provide you with preventative tools for managing migraine. Everyone has different triggers, but there are a few common culprits that affect a large number of people living with migraine. When you can identify your triggers, you are one step closer to effectively managing your migraine and avoiding future attacks.
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What Kind Of Headache Do I Have
If youve ever found yourself asking this question, you arent alone. There are actually many different kinds of headaches. Knowing which type you have is an important step forward to getting an accurate diagnosis. That leads to the right treatment and long-lasting relief.
Heres how to tell what kind of headache you have: