Typical Diagnostic Clues for Migraine

Migraine headache diagnosis is normally based on the patient's history, a normal neurological examination, and the absence of any other cause for headache.

Migraine is usually a stereotypical syndrome, intermittent in nature, characterized by an aura in approximately 20% of the cases. If the aura is present (migraine with aura), it is normally followed by either unilateral or bilateral pain. This pain increases in intensity steadily. It is often associated with nausea and vomiting, sensitivity to light (photophobia), and sensitivity to sound (sonophobia). The nature of the pain can vary, although the most characteristic is a "throbbing" sensation. The diagnosis of migraine may be made, however, without the characteristic throbbing pain.

The duration of a regular migraine headache is normally 4-72 hours. If the migraine lasts more than 72 hours, it is then called, "status migrainosus."

International Headache Society Diagnosis Criteria for Migraine

• Without aura

  1. At least 5 attacks fulfilling 2-4

  2. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)

  3. Headache has at least two of the following four characteristics:

  • unilateral location
  • pulsating quality
  • moderate or severe intensity which inhibits or prohibits daily activities
  • aggravated by walking stairs or similar routine physical activity

  4. During headache at least one of the two following symptoms occur:

  • nausea and/or vomiting
  • photophobia and phonophobia

  5. At least one of the following three characteristics is present:

  • history and physical and neurological examinations do not suggest one of the disorders listed in 5-11
  • history and/or physical and/or neurological examinations do suggest such a disorder, but it is ruled out by appropriate investigations
  • such a disorder is present, but migraine attacks do not occur for the first time in close temporal relation to the disorder

• With aura

  1. At least two attacks fulfilling 2

  2. Headache has at least three of the following four characteristics:

  • one or more fully reversible aura symptoms indicating focal cerebral cortical and/or brain stem dysfunction
  • at least one aura symptom develops gradually over more than 4 minutes, or two or more symptoms occur in succession
  • no aura symptom lasts more than 60 minutes; if more than one aura symptom is present, accepted duration is proportionally increased
  • headache follows aura with a free interval of less than 60 minutes (it may also begin before or simultaneously with the aura)

  3. At least one of the following three characteristics is present:

  • history and physical and neurological examinations do not suggest one of the disorders listed in groups 5-11
  • history and physical and neurological examinations do suggest such a disorder, but it is ruled out by appropriate investigations
  • such a disorder is present, but migraine attacks do not occur for the first time in close temporal relation to the disorder