An accurate diagnosis of any condition is the first step towards conquering it.

The most obvious step before treating any condition is its right diagnosis. Researchers have demonstrated that it is almost always possible to make specific diagnosis of chronic migraine, and by making this diagnosis, one opens up a substantial number of treatment options1.

If you suffer from severe headaches for minimum 15 days in a month, then your headache falls under the chronic migraine category1. In such a scenario, it is crucial that you consult a doctor for long term relief.

Diagnosing migraine at the earliest is beneficial in 2 ways –

Firstly, it can give you an assurance that your headache and other symptoms are due to migraine attacks and not any serious brain related disorder.

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Secondly, a confirmed diagnosis from your doctor helps you to manage migraine and its symptoms with appropriate treatment and this gives you an opportunity to enjoy peaceful, migraine-free days.

How is migraine diagnosis made?

There are 4 major steps involved in making accurate migraine diagnosis. They are –

1) Recognising the pattern:

Your doctor will ask you questions about your headache. He would want to know

  • At what age the headaches first started,
  • How severe they are,
  • How often it occurs,
  • How long does the headache last, and
  • What other symptoms are accompanied with it

In case you are unable to answer correctly, or feel your response is not enough for the doctor to identify the disorder, he may ask you to maintain a migraine diary.

2) Identifying the disorder:

Migraine is the commonest cause of recurrent, severe headache. Once your pattern of headache is established, your doctor will further probe and check if your headaches meets the criteria for migraine set by International Classification of Headache Disorders, which are1

  1. Headache attacks lasting 4–72 h (untreated or unsuccessfully treated)
  2. Headache has at least two of the following four characteristics:
  • unilateral location
  • pulsating quality
  • moderate or severe pain intensity
  • aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)

During headache you have at least one of the following:

  • nausea and/or vomiting
  • photophobia and phonophobia

If you have experienced at least 5 attacks fulfilling criteria 1 and 3, your doctor will recognise your headaches as migraine.

About 20% of migraine sufferers also experience an aura1, usually before the headache starts. Most aura is visual in nature, consisting of a combination of positive visual phenomena such as floaters, flashes of light, moving or expanding zig-zag patterns, and negative phenomena such as loss of vision causing blind spots etc. Inform your doctor if you experience any visual disturbance before the onset of headache.

3) Detailed history:

Sometimes headaches may not be migraine but some other underlying disorder caused due to a previously traumatic event. Describing your first headache and its severity will help fill out the gaps in diagnosing migraine fully.

4) Other investigations:

Your doctor may also recommend more tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe.

Blood tests: These identify any blood vessel problems, and infections in spinal cord or brain

Magnetic resonance imaging (MRI): MRI scans help doctors diagnose tumours, strokes, bleeding in the brain, infections, and other brain and nervous system (neurological) conditions.

Computerized tomography (CT) scan:  A CT scan helps doctors diagnose tumours, infections, brain damage, bleeding in the brain and other possible medical problems that may be causing headaches.

After migraine is identified –

Once your doctor confirms migraine, he will immediately put you on medicines and advice lifestyle modifications. Please bear in mind that migraine medicines are different from regular pain killers. Following doctor’s advice and treatment will successfully manage your migraine headaches; however migraine headache cannot be “cured” completely.

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Ref:

  1. Ther Adv Chronic Dis. 2015 May; 6(3): 115–123.