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How Do Doctors Diagnose Migraines

What Are Some Migraine Risk Factors And Triggers

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Some things make you more likely to get migraine headaches . Other things may bring on a migraine .

Common migraine risk factors include the following:

  • Family history: You are much more likely to have migraines if one or both of your parents had migraines.
  • Sex: Women are more likely than men to have migraines.
  • Age: Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.

Common migraine triggers include the following:

  • Food and drink: Certain food and drink may cause migraines. Dehydration and dieting or skipping meals may also trigger migraines.
  • Hormone changes: Women may experience migraines related to their menstrual cycles, to menopause, or to using hormonal birth control or hormone replacement therapy.
  • Stress: Stress may trigger migraines. Stress includes feeling overwhelmed at home or work, but your body can also be stressed if you exercise too much or dont get enough sleep.
  • Senses: Loud sounds, bright lights , or strong smells may trigger migraines.
  • Medicines: Certain medicines may trigger migraines. If you think your migraines might be related to your medicine, talk to your doctor. Your doctor may be able to prescribe a different medicine.
  • Illness: Infections, such as the cold or the flu, may trigger migraines, especially in children.

Foods that may trigger migraines:

  • aged, canned, cured, or processed meat
  • aged cheese
  • soy sauce

Can You Prevent Migraine

If youve already been diagnosed with migraine, your doctor can help you figure out the best prevention methods. Often, your first step will be keeping a migraine journal so that you can figure out what triggers your attacks and avoid them.

Many migraine triggers are related to everyday health habits. This includes:

  • not getting enough sleep
  • not exercising enough
  • being under stress

For some people, managing those things can help you prevent or lessen migraine. You can also avoid common trigger foods and drinks, such as:

  • chocolate

Diagnosing The Type Of Headache

The crucial distinction we make when diagnosing a headache is determining whether it is a primary headache or a secondary headache:

  • Primary headaches, the most common type of headaches, are painful, but not dangerous. A primary headache is not a symptom of an underlying disease or condition. For primary headaches, headache trigger trackers and headache diaries can be effective tools to help diagnosis the cause of your headaches.
  • Secondary headaches are characterized by excruciating pain, usually caused by another, more serious, condition.

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Whats A Migraine What Does A Migraine Feel Like

A migraine is a common neurological disease that causes a variety of symptoms, most notably a throbbing, pulsing headache on one side of your head. Your migraine will likely get worse with physical activity, lights, sounds or smells. It may last at least four hours or even days. About 12% of Americans have this genetic disorder. Research shows that its the sixth most disabling disease in the world.

Can Migraines Be Prevented Or Avoided

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Medicine to prevent migraines may be helpful if your headaches happen more than 2 times a month. You may want to consider this medicine if your headaches make it hard for you to work and function. These medicines are taken every day, whether you have a headache or not.

Preventive medications for migraines can include prescription drugs often used to treat other ailments. Anti-seizure medicines, antidepressants, medicines to lower blood pressure, and even Botox injections are some of the preventive medications your doctor may prescribe. Calcitonin gene-related peptide inhibitors can also help prevent migraines. They do so by blocking a gene-related peptide in your sensory nerves. This peptide is known to increase during a migraine attack, so blocking it can help prevent migraines.

There are also a number of non-medical treatments designed to help minimize migraine pain and frequency. One is an electrical stimulation device, which has been approved by the FDA. It is a headband that you wear once a day for 20 minutes to stimulate the nerve linked to migraines. Another non-medical treatment is counseling aimed at helping you feel in more control of your migraines. This counseling works best when paired with medical prevention of migraines, as well.

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Testing & Diagnosis For Headaches In Children

If your child is having headaches, one of the first things youll want to do is to get a solid understanding of her symptoms. Recording her headaches in a headache diary can help you see exactly how often theyre happening, understand your childs symptoms better and notice possible causes or triggers. A record like this is also a good way for you to share information with your childs health care providers.

In order to diagnose your childs type of headaches, find the cause and recommend treatment, your childs doctor will review her medical history, talk with you and your child about the symptoms and perform a physical and neurological exam. Questions that your doctor may ask include:

If your childs symptoms indicate that her headaches are primary headaches , and if her neurological exam is normal, no further diagnostic testing may be needed.

Our neurologists at Boston Childrens Hospital will obtain a detailed history and perform a careful exam to determine whether your childs headaches could be caused by another medical problem. If needed, your childs doctor may order diagnostic tests including:

  • blood tests
  • brain imaging scans

Our headache team will spend time talking with you and learning possible causes of your childs headache pain. With your permission, we can also speak with your other health care providers or your childs school to help us assess the situation.

What Medicines Help Relieve Migraine Pain

For mild to moderate migraines, over-the-counter medicines that may help relieve migraine pain include:

  • aspirin
  • acetaminophen
  • an acetaminophen, aspirin, and caffeine combination
  • ibuprofen
  • naproxen
  • ketoprofen

People who have more severe migraines may need to try abortive prescription medicines. A medicine called ergotamine can be effective alone or combined with other medicines. Dihydroergotamine is related to ergotamine and can be helpful. Other prescription medicines for migraines include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan.

If the pain wont go away, stronger pain medicine may be needed, such as a narcotic, or medicines that contain a barbiturate . These medicines can be habit-forming and should be used cautiously. Your doctor may prescribe these only if they are needed and only for a short period of time.

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What Medications Are Used To Relieve Migraine Pain

Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.

Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:

  • Excedrin® Migraine.
  • Advil® Migraine.
  • Motrin® Migraine Pain.

Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.

Prescription drugs for migraine headaches include:

Triptan class of drugs :

  • Sumatriptan.
  • Butterbur.
  • Co-enzyme Q10.

Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.

Drugs to relieve nausea are also prescribed, if needed.

All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare providers advice.

What Are The Steps Of Migraine Diagnosis

How are migraines diagnosed?

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.

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Treatment Of Chronic Migraine

There are three broad approaches to treating chronic migraine: lifestyle and trigger management, acute treatments , and preventive treatments . While many patients find that lifestyle adjustments such as regularizing meals and sleep can reduce the frequency of their attacks, some form of medication or other treatment is almost invariably necessary in patients with chronic migraine. The National Institute for Health and Care Excellence have recently published guidance on the diagnosis and treatment of migraine, and further consensus guidelines have been published by the British Association for the Study of Headache, the American Headache Society and American Academy of Neurology, and the European Headache Federation .

How Can I Prevent Headaches

The key to preventing headaches is figuring out what triggers them. Triggers are very specific to each person what gives you a headache may not be a problem for others. Once you determine your triggers, you can avoid or minimize them.

For example, you may find that strong scents set you off. Avoiding perfumes and scented products can make a big difference in how many headaches you have. The same goes for other common triggers like troublesome foods, lack of sleep and poor posture.

Many people, however, are not able to avoid triggers or are unable to identify triggers. In that case, a more personalized multidisciplinary approach with a headache specialist is often necessary.

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Who Gets Migraines What Are The Risk Factors

Its difficult to predict who may get a migraine and who may not, but there are risk factors that may make you more vulnerable. These risk factors include:

  • Genetics: Up to 80% of people who get migraine headaches have a first-degree relative with the disease.
  • Gender. Migraine headaches happen to women more than men, especially women between the ages of 15 and 55. Its likely more common in women because of the influence of hormones.
  • Stress level. You may get migraines more often if youre high-stress. Stress can trigger a migraine.
  • Smoking.

How To Prepare For A Doctor Appointment To Discuss Potential Migraine Symptoms

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  • 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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Are Headaches Hereditary

Headaches have a tendency to run in families, especially migraines. Children who have migraines usually have at least one parent who also suffers from them. In fact, kids whose parents have migraines are up to four times more likely to develop them too.

Headaches can also be triggered by environmental factors shared in a familys household, such as:

  • Eating certain foods or ingredients, like caffeine, alcohol, fermented foods, chocolate and cheese.
  • Exposure to allergens.
  • Strong odors from household chemicals or perfumes.

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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How Is Abdominal Migraine Similar To A Migraine

Abdominal migraine and migraine share similar triggers, such as stress, skipping meals, exposure to bright light, poor sleep, and foods containing chocolate, caffeine, and monosodium glutamate . Because there are so few studies on medications used to treat abdominal migraine, patients with the condition are often treated with medications shown to be effective on a migraine.

Who Is At Risk For Abdominal Migraine

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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.

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How Much Does The Average Doctor Know About Migraines

How Much Does The Average Doctor Know About Migraines?

The migraine education of an average doctor is reviewed in this article. I also discuss how the health care system sets doctors up for failure.

Eight Reasons Why Hospitals Fail Migraine Patients:

1. Migraine Education or Lack Thereof

On average, doctors only receive FOUR hours of education for all headache disorders, including migraines .

It would take longer than four hours to read my 500-page book and that book only scratches the surface of one headache disorder: migraines.

There are over 300 headache disorders and this leaves almost no time for migraines. Many doctors receive ZERO hours of headache education .

2. Neurologist Migraine Education or Lack Thereof

Neurology residency lecture hours range from one hour to five plus hours for all headache disorders .

A neurologist could potentially spend ZERO hours on headache education in medical school and ONE hour during neurology residency.

According to Dr. Robert Cowan, a neurology professor and director of the headache program at Stanford, the average medical student gets about two hours of education on all headaches and he or she might get another two hours if neurology is pursued .

3. Migraine Specialists Are Few and Far Between

There are only about 500 headache specialists in the United States who have demonstrated competence in headache healthcare .

Some states have zero headache specialists .

4. 20-Minute Healthcare

5. Misdiagnosis

6. Theres No Consistency

Doctors For Children With Migraine

Children are not little adults, so treating migraine in children means different kinds of specialists. Most children with migraine and other headache disorders see their pediatrician first. A pediatrician is a doctor who is trained to treat illness in children. If a child has migraines that are hard to treat, you may need to see a specialist.5

A pediatric neurologist specializes in treating children with migraine and other nervous system issues. A pediatric headache specialist or pediatric neurologist may work on a team in a headache center. This team may also include psychologists, physical therapists, and dietitians who all treat migraine in children.

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How Common Are Headaches In Adults

If your head is throbbing, youre not alone. Headache is one of the most common pain conditions in the world. Up to 75% of adults worldwide have had a headache in the past year.

Headaches are a major cause of absenteeism from work and school. They also take a toll on social and family life. For some people, continually battling headaches can lead to feeling anxious and depressed.

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Provided one of the serious conditions noted above is not present, relatively simple treatment options can be considered. To treat symptoms and prevent the frequency and severity of headaches, physicians may try to identify headache “triggers,” such as stress or certain foods, and recommend treatment options including:

  • preventive medications and treatments.
  • lifestyle changes, including stress management and relaxation techniques.
  • pain-relieving medication, such as acetaminophen or ibuprofen. Children and adolescents should avoid taking aspirin. In rare cases, aspirin can cause Reye Syndrome, a serious and potentially fatal condition.

If your headache is the result of an underlying medical condition or injury, your physician will discuss treatment options with you.

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Gathering Your Medical History

Your doctor will need to gather a lot of information about your personal medical history and your family medical history to diagnose migraine.

Theyll ask you to provide as many details as you can about your symptoms. Theyll also want to know about any other medical conditions youve been diagnosed with and about any other symptoms youve been having recently.

Youll be asked about your diet, stress levels, activity levels, and other aspects of your lifestyle.

Your doctor might ask you to keep a migraine journal until your next appointment. In the journal, youll record every time you have pain and describe what that pain feels like.

You can also record anything you do for the pain at home and whether it helps at all. For example, you might want to make note of whether certain over-the-counter medications help.

Youll need to provide as much family health history as you can. Since migraine tends to run in families, its important for the doctor to know whether you have any relatives whove been diagnosed with migraine. Its also important to let them know about any other conditions that run in your family.


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