Diagnosis of Migraine

One of the most frequent reasons for consultation is migraine, a neurological disorder that can be very disabling and requires a lot of self-care.

In general terms, we could say that migraine is a type of headache that usually throbs (as if you were being hit on the head), and it can go from moderate to intense until it becomes totally disabling. In this article we’ll look at the topic of the diagnosis of migraine?

The diagnosis of migraine involves a process that, depending on the person, can take varying lengths of time. For example, if you have a family history of migraines and have been able to keep a record of how it affects you, the doctor will have more information and will be able to determine the most relevant tests to reach the correct diagnosis a lot quicker.

All the information you can provide in the first appointment with the doctor, together with your family history, medical history and some physical and neurological exams will be very useful. However, prior to all this, there’s the self-evaluation.

Self-evaluation

When you have discomfort (be it a possible migraine or something similar), the first thing you can do is self-assess. To do this, you can ask the following questions:

• What’s the pain like?
• What areas does it reach?
• How long does it last?
• What other discomfort does it cause me? For example, nausea, dizziness, pain or stiffness in the neck and shoulders, lack of energy, drowsiness, confusion, difficulty concentrating, etc.
• Has it prevented me from continuing with my routine and to what extent?
• What do I suspect could have caused the discomfort?
• Has it been a specific discomfort (due to menstruation or lack of sleep, for example) or is it recurrent?
• Did I notice any “warning signs” before the pain itself? For example, sensitivity to light, sounds, smells, irritability, fatigue, etc.
• Does the discomfort get worse with physical exertion?

Some doctors recommend keeping a diary or notebook to keep a record of the discomfort and be able to obtain more information about it. Nowadays you can do this on the mobile or tablet, an app for migraine headaches, or in a paper notebook, whatever you prefer.

If you’ve already experienced migraines, chances are you’ve identified a specific pattern. Thus, each time you have a new episode, you have more or less an idea of what it’s going to be like and what has been helpful at our times.

The pattern is usually maintained over time. However, if it suddenly changes and you don’t know what could be happening to you and you notice symptoms like the ones we’re going to mention below, you should see your doctor as soon as possible.

• High fever
• Rashes
• Loss of consciousness
• Constant vomiting and inability to keep food and liquids in the stomach
• Loss of vision (in one or both eyes) and other unusual symptoms

Lab tests

In addition to the information that you can provide to the doctor in the initial consultation, the doctor will perform a physical examination to detect symptoms that may indicate a neurological defect. This may include the following, according to Dr. Julián Pascual, an expert in Neurology at the University Hospital of Salamanca:

• Vital signs check (blood pressure and heart rate)
• Cardiac auscultation
• Examination of the pericranial structures (paranasal sinuses, arteries, paraspinal muscles and temporomandibular joint)
• Degree of mobility and presence of tenderness in the cervical region

The neurological examination will include meningeal symptoms, fundus, visual fields, pupils, facial sensitivity, strength, tendon reflexes, plantar responses and gait.

Blood tests and other tests

After the physical exam is complete, they may order a blood test to check your levels. Some of the types of blood tests you may order are:

• Complete blood count
• Electrolyte levels
• Thyroid tests

Other tests could include:

• Encephalogram
• Echocardiogram
• Lumbar puncture

Imaging tests

According to Mayo Clinic experts, some imaging tests may be required to reach a diagnosis of migraine. The most common are magnetic resonance imaging and computed tomography.

Brain computed tomography (CT) scan

The computed tomography of the brain is one of the most required tests to be able to reach the diagnosis of migraine. It helps detect tumors, infections, and other medical problems that may be behind the headache.

As indicated in an article published in the journal Anales de Radiología México, “its main utility lies in excluding the presence of structural alterations as a secondary cause of headache”.

Magnetic resonance imaging of the brain (MRI)

The magnetic resonance image of the brain or MRI “allows you to obtain an image of the inside of the body without using x-rays or other ionizing radiation. The MRI can show small details about different tissues”, according to the experts at Medline Plus.

This test can detect tumors, brain hemorrhages, infections and other conditions of the nervous system that can explain some causes of migraine.

Other tests that the doctor might order would be an angiogram or CT or MRI of the cervical spine.

Differential diagnosis

“Although neurologists are five times more likely to correctly diagnose a migraine than general practitioners, many consider the diagnosis of a tension-type headache first“, a recent update on the topic exposes.

The diagnosis of migraine isn’t easy, and, because of that, it’s necessary to be patient during the process. However, science doesn’t stop working to improve this situation. Today, the International Headache Society makes several guides available to experts in order to facilitate diagnosis.