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The diagnosis of migraine headache is based on:

• Physical examination
• Family history of migraine headache

• Distinguishing between primary and secondary headache

  • Age of onset of first headache
  • Neurologic findings
  • History of infection or trauma
  • Severity of pain at onset of headache

• Distinguishing migraine from other types of primary headaches

  • Frequency, duration, and intensity of attacks
  • Location of pain
  • Presence of photophobia, phonophobia, and nausea/vomiting

• Presence of classic migraine symptoms - nausea raises the probability of a diagnosis of migraine headache to 90%.

If headache symptoms are typical of migraine and there is a family history of migraine headaches, the diagnosis can be made on the basis of signs, symptoms, and physical examination. In order to confirm a diagnosis, or to better understand patient reporting, the physician may request that the patient keep a careful headache diary to track patterns that lead up to headache onset, such as diet, time of day, intensity, and duration of pain, location of pain, sleep patterns, etc.

If meningitis or subarachnoid hemorrhage is suspected, the physician may perform a lumbar puncture (spinal tap). Otherwise, the physician may order imaging studies to rule out other causes of headache.

If headache symptoms are typical of migraine and there is a family history of migraine headaches, the diagnosis can be made on the basis of signs, symptoms, and physical examination. In order to confirm a diagnosis, or to better understand patient reporting, the physician may request that the patient keep a careful headache diary to track patterns that lead up to headache onset, such as diet, time of day, intensity, and duration of pain, location of pain, sleep patterns, etc.

If meningitis or subarachnoid hemorrhage is suspected, the physician may perform a lumbar puncture (spinal tap). Otherwise, the physician may order imaging studies to rule out other causes of headache.

Imaging Studies

Under certain circumstances, the physician may order imaging studies in order to rule out other medical conditions. Studies include:

• Computerized Tomography Scan (CT) - to rule out tumors or infections
• Magnetic Resonance Imaging (MRI) - to rule out tumors, stroke, aneurysm, brain abnormalities, and to visualize blood vessels

Imaging studies may also be ordered in the presence of:

• Severe, acute headache onset (thunderclap headache)
• Abnormal responses to neurological testing
• Vomiting, if it is unusual for the patterns of the patient's headaches
• Headache exacerbated by physical exertion
• Adult-onset migraine type headache
• Change in previous headache pattern

Diagnostic Workup for Children

The diagnostic workup for children suffering from headache is similar to adults but certain variations must be kept in mind, such as headaches may be bilateral, the child may not be able to verbalize sensitivity to light but may behave in such as way to make it clear (prefer to be in a dark room or quiets down in a dark room).

There are a wide range of symptoms in children that may make a definitive diagnosis of migraine difficult to establish, especially in very young children who may get migraines before they are effectively able to communicate. For example: