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Recurrent migraines can take a toll on the day to day life. They can affect your daily activities, productivity, studies or your social life. There can be a number of causes for migraines like emotional stress, physical stress, hormones, iatrogenic or environmental factors. Other than these, migraines can occur as a result of a stroke, tumor or hemorrhage. These conditions are serious and need immediate medical attention. This is why it is so important to get a diagnosis for a migraine so that further complications can be avoided. So how are migraines diagnosed? Keep reading to find out.
How are migraines diagnosed?
A doctor can diagnose your migraines based on your past medical history, symptoms, physical and neurological exam, and scans. You should first go to your GP (general physician) who can refer you to a neurologist in case he/she is unable to make a diagnosis or if the treatment does not seem to be working. A neurologist can better access you in this case and make a clear diagnosis of the underlying issue.
Medical history
The doctor will ask you about your symptoms, past medical history, family history, triggers, and any medication that may have helped you with the migraines in the past. The medical history can include:
- Since when are you experiencing migraines? How long has it been?
- How often do they occur?
- How long do they last?
- The doctor can ask if you are aware of any possible triggers such as stress, exhaustion, a certain type of diet etc.
- It is also important to know whether any one in your immediate family also experiences migraines.
- The nature of pain i.e. throbbing, pulsating, constant or dull.
- Is the pain localized to one area of your skull or is it generalized?
- The severity of the pain. Is it affecting your daily activities?
- Any other symptoms accompanied by the headaches.
- Do the headaches get worse with movement?
- Any medication that has been prescribed to you previously or in case of self medication, did it help?
Migraines are usually accompanied by other symptoms as well. So the doctor can ask you the following questions to be able to make a clear diagnosis:
- The doctor can ask if you experience any visual and sensory disturbances such as sensitivity to light, blind spots, flashes of light, sparks, tinnitus (ringing in the ears), sensitivity to loud noises, or dizziness. These symptoms are collectively referred to as ‘aura’. Aura can occur before the headaches or can be accompanied by them.
- Any nausea, vomiting, loss of appetite.
- Any mood changes.
The doctor can also ask you about any medical condition that you have been diagnosed with and are on a treatment plan for. It is also important for the doctor to know about your lifestyle in case any lifestyle choice is triggering the migraine for example, your diet, physical activity, sleep cycle, stress levels, etc.
Migraine diary
Tracking your symptoms can provide useful insight to your doctor. Your doctor may ask you to record your symptoms and their pattern in a smartphone app or a journal and bring it with you to the next appointment. You should record the following:
- The time of day you usually get migraines.
- How long do they last?
- Note down every time they occur.
- The nature of pain and severity.
- If you took any medication then write it down and also whether it helped or not.
Physical and Neurologic exam
The next step after medical history is an exam. The doctor will check your pulse, breathing, and blood pressure. He/She might also check for fever which may indicate an infection.
Neurologic exam consists of checking the reflexes, sensations, short-term memory, and strength. Tests for vision and cranial nerve functions are carried out as well. The doctor will also examine your head, neck and shoulders.
Most often, medical history and examination are enough to make a diagnosis for migraine.
Scans
Doctors can order scans in case the history and examination are not conclusive of if your symptoms do not align with those of migraine. Scans are ordered to rule out other serious medical conditions that could be the culprit. Commonly used scans are:
CT scan: CT scans create a detailed image of the head and brain using a series of X-rays. They can help look for aneurysms, hemorrhage, tumors etc.
MRI: MRI uses magnetic waves instead of X-rays to create a detailed image of the brain. It is used to look for an infection, abscess, tumor, stroke etc.
Diagnostic criteria for migraines
The diagnostic criteria for migraine is that the patient has had at least 5 headaches that have lasted 4-72 hours and have 2 or more of the following characteristics:
- Throbbing or pulsating pain
- Pain on one side of the head (unilateral)
- Severe or moderate pain
- Made worse by moving or physical activity
The bottom line
Migraines are severe to moderate headaches that are pulsating or throbbing in nature. The headaches are usually preceded by or accompanied by ‘aura’ which includes photophobia (sensitivity to light), phonophobia (sensitivity to noise), nausea, vomiting and loss of appetite. Migraines usually affect both men and women, however, they are more common among women.
A doctor can diagnose you based on your medical history, physical and neurologic exam, and scans. You should first visit your GP (general physician) because they can also diagnose migraine since it is very common. Your GP can refer you to a neurologist in case the diagnosis is unclear or the symptoms point towards another underlying condition. The diagnostic tests such as CT scan or MRI are ordered to rule out other causes of headaches. It also helps if you keep a migraine journal to track your symptoms.
The treatment of migraine includes painkillers like acetaminophen, aspirin and ibuprofen. These medications are available over the counter. Doctors can also prescribe opioids but they are addictive so they should only be taken as prescribed. Antiemetics are prescribed along with painkillers to relieve nausea. Triptans are prescribed to patients in which other over-the-counter painkillers do not seem to be working.
Preventative drugs used for migraines are beta-blockers, calcium channel blockers, anticonvulsants, antidepressants and Botox injections.
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