Learn how migraine disorders are diagnosed through clinical evaluation. Understand the role of MRI, CT scans, and keeping a headache diary for accurate diagnosis.
Send us all your questions or requests, and our expert team will assist you.
Diagnosis and Imaging
Diagnosing a migraine disorder is primarily a clinical process. This means there is no single blood test or X ray that can definitively say you have a migraine. instead, the diagnosis is made based on the story you tell your doctor. The International Headache Society has established strict criteria for diagnosing migraine.
To be diagnosed, a patient typically must have had at least five attacks that meet specific criteria. The attacks must last between 4 and 72 hours. The headache must have at least two of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, and aggravation by routine physical activity. Additionally, there must be nausea, vomiting, or sensitivity to light and sound.
The migraine examination is performed to rule out other causes of headaches. The neurologist looks for “red flags” that might suggest a secondary headache disorder. A secondary headache is one caused by another condition, such as an infection, a tumor, or a bleed. The exam focuses on the function of the brain and nerves.
The doctor will examine the head and neck for tenderness or muscle spasms. They will check the temporomandibular joint (TMJ) for clicking or pain. They will listen to the arteries in the neck with a stethoscope to ensure normal blood flow. The goal is to confirm that the physical structure of the head and neck is normal.
During the neurological part of the exam, the doctor will test your cranial nerves. This involves checking your vision, hearing, eye movements, and facial sensation. They will look into the back of your eyes using a light to check the optic nerve for signs of increased pressure in the brain.
They will test your motor system by asking you to push and pull against resistance. Reflexes are checked with a rubber hammer. Coordination is tested by asking you to touch your nose with your finger or walk in a straight line. If all these physical tests are normal, it supports the diagnosis of a primary headache disorder like migraine.
Magnetic Resonance Imaging (MRI) is the preferred imaging study for evaluating headaches. An MRI uses powerful magnets and radio waves to create detailed images of the brain. It is very good at showing the soft tissues of the brain.
An MRI is not always necessary for a typical migraine diagnosis. However, it is ordered if there are atypical symptoms. These might include a sudden change in headache pattern, headaches that start after age 50, or abnormal findings on the physical exam. The MRI is used to rule out tumors, strokes, aneurysms, and structural abnormalities like Chiari malformation.
A Computerized Tomography (CT) scan uses X rays to create cross sectional images of the brain. It is less detailed than an MRI but is much faster. A CT scan is typically used in emergency situations.
If a patient arrives at the emergency room with the “worst headache of their life” (thunderclap headache), a CT scan is done immediately to rule out bleeding in the brain. It is also useful for checking the skull for fractures or the sinuses for infection. For routine migraine diagnosis, MRI is generally preferred over CT.
One of the most valuable diagnostic tools is a headache diary. Doctors will often ask patients to keep a log of their headaches for at least one month. This diary should record the date and time of the attack, the duration, the severity of the pain, and any potential triggers.
The diary helps the doctor see patterns that the patient might miss. It can reveal a link to the menstrual cycle, weekend sleep patterns, or specific foods. It also helps in tracking how often acute medication is being used, which is crucial for preventing medication overuse headaches.
A major part of the diagnostic process is excluding other conditions that mimic migraine. Sinus headaches are frequently confused with migraines because both can cause pressure in the face. However, sinus headaches usually involve fever and thick nasal discharge, which migraines do not.
Tension headaches are another common mimic. The doctor differentiates them by the quality of pain (pressure vs throbbing) and the absence of nausea in tension headaches. Cluster headaches are distinguished by their shorter duration and extreme severity around one eye, often accompanied by tearing and a runny nose.
Beyond the basic exam, specific neurological tests may be done if the aura symptoms are complex. For example, if a patient has a visual aura, a detailed visual field test might be performed to ensure there is no damage to the visual pathways.
If vertigo is a major symptom, vestibular testing might be ordered. This checks the balance organs in the inner ear. These tests help confirm if the dizziness is related to the migraine brain or an ear problem.
Blood tests are generally normal in people with migraine. However, they are used to rule out systemic illnesses that can cause headaches. A complete blood count (CBC) can check for infection or anemia. Thyroid function tests are often done because thyroid disorders can worsen headaches.
Erythrocyte sedimentation rate (ESR) or C reactive protein (CRP) tests measure inflammation. Elevated levels might suggest a condition called temporal arteritis, which is an inflammation of the arteries in the head that requires immediate treatment to prevent blindness.
Imaging is not recommended for patients with a stable history of migraine and a normal neurological exam. Unnecessary imaging can lead to finding incidental harmless anomalies that cause anxiety. However, there are strict guidelines for when imaging is mandatory.
Imaging is required if:
Send us all your questions or requests, and our expert team will assist you.
Migraine is diagnosed based on clinical history and symptom patterns rather than a single test.
Most people with typical migraine do not need imaging unless there are unusual features.
No, imaging is used to exclude other causes, not to confirm migraine.
Yes, a normal exam supports the diagnosis of migraine as a primary headache disorder.
Yes, diagnosis may be reassessed if symptoms change or new features appear.
Did you know brain surgery can really change how people talk? Many face big challenges with speaking after surgery. The surgery’s complexity and its effects
Leave your phone number and our medical team will call you back to discuss your healthcare needs and answer all your questions.
Your Comparison List (you must select at least 2 packages)
