How is Migraine Diagnosed?

Migraine is a neurological headache disorder that causes painful symptoms such as head pain, nausea, and light and noise sensitivity. Migraine is often underdiagnosed, so it's important to know the symptoms and visit your provider if you think you're experiencing migraine.

There is no one sole examination that tests for migraine—so, your provider can use a combination of tests to detect migraine and help you figure out a treatment plan. During your appointment, it’s standard practice for your provider to ask you about your medical history and perform a routine physical exam. They may also use neurological and imaging tests to confirm a diagnosis or rule out other headache-related conditions.

Medical History and Physical Exam

Your primary healthcare provider or a neurologist (a doctor that specializes in the brain) can diagnose you with migraine. At your appointment, your provider will usually start with an oral medical history to learn more about your symptoms. 

The American Migraine Foundation recommends keeping a headache journal. Before going in for your appointment, you may find it helpful to log when your migraine episodes happen, what symptoms you experience, how severe the symptoms are, and what might be triggering your episodes.  

To learn more about your medical history, your provider may ask you questions such as:

• What symptoms are you experiencing?
• How long have you had symptoms?
• How long do symptoms usually last?
• How severe are your symptoms?
• Have your symptoms limited your ability to perform daily life tasks? 
• In what area of your head do you feel the most pain?
• Are you experiencing aura (or, seeing zig zag lines)?
• Does anyone in your family have a history of migraine?
• Are you taking any medications right now?
• Do you drink alcohol or caffeine, or use any substances?
• Are you experiencing any stress or anxiety?
• Have you recently gone through life changes or had any infections?
• Are there any foods, drinks, sounds, or smells that trigger your symptoms? 

During your physical exam, your provider will usually:

• Measure your vitals (e.g., heart rate, blood pressure, body temperature, breathing) 
• Examine your head for any bumps, bruises, or other signs of injury 
• Check your eyes and nose for signs of infection
• Look at your neck and throat to examine pain, stiffness, or swollen lymph nodes
• Perform a neurological exam

Your medical history and physical assessment can help your provider get a better understanding of your condition and overall health. Based on your discussion, they may also have a better idea of how to move forward with other testing measures. 

Neurological Exams

Neurological exams are standard practice during your physical exam. Your provider will likely perform a neurological exam to rule out conditions, including stroke, a brain mass, infection, aneurysm, among other diseases that affect the brain or nerves.

During a neurological exam, your healthcare provider will be checking your:

• Motor strength test: This test helps your provider look for signs of muscle weakness, tenderness, and range of motion in your limbs and joints.
• Cognitive function: Your provider may ask you general questions, such as your name, time, place, or date. They may also ask you to do memory or language tasks that require you to remember the order of items in a list, identify objects, or draw shapes without looking at a reference.
• Physical coordination: The exam may also look at your balance and movement skills. Tasks may include walking in a straight line or grasping objects. 
• Reflexes: A reflex test can show your provider how you respond to physical stimulation. To do this, your provider may use a rubber mallet to tap on certain joints in your body to see if and how they respond. 
• Sensation: If numbness and tingling are accompanying headaches, your provider may test your sense of touch. They may examine how your body responds to heat, cold, and pain sensitivity. 
• Eye movements: It's common for your provider to examine your eyes to look for inflammation, redness, or damage, which can signal an increase in pressure in your brain.

Imaging Tests

Generally, your provider can use your medical history and physical exams to diagnose you migraine. Imaging tests are not typically necessary for migraine, but similar to a neurological exam, imaging tests can detect damage to the brain and rule out other conditions. Your healthcare provider may choose to order one or more of the following imaging tests:

• Computerized tomography (CT) scan: A CT scan uses several X-ray images to produce a detailed model of your brain. This test can spot tumors, bleeding, and infections in your brain.
• Magnetic resonance imaging (MRI): An MRI uses magnetic waves to create a picture of your brain. This scan can detect signs of stroke, inflammation, tumors, and infection in your brain. 

Diagnostic Criteria 

Migraine symptoms can often mimic the symptoms of other headache-related conditions. This is why receiving a migraine diagnosis (and getting the proper treatment) can be difficult for some people. 

However, your healthcare provider will use the information from your medical history, physical exam, and other measures to help them identify the type of headache disorder that you have. According to the International Classification of Headache Disorders, your provider will use the following diagnostic criteria to give you an official diagnosis for migraine:

A Quick Review 

Migraine can be debilitating and unpredictable type of headache disorder that can cause painful symptoms and interrupt your daily life.

While there is no single test for the condition, your healthcare provider will likely use a combination of a thorough medical history, physical exam, and neurological exam to make a diagnosis. If your diagnosis isn't clear or your provider finds something concerning in your exam or medical history, they may order additional imaging tests to confirm a diagnosis or rule out other conditions.

Symptoms of migraine can mimic other conditions. It is common for your provider to screen for tension or cluster headaches, stroke, seizures or epilepsy, brain aneurysm, and multiple sclerosis (MS) during your diagnostic process. 

If you begin to experience symptoms of migraine or have active migraine episodes, it’s good practice to contact your healthcare provider for proper testing. Getting evaluated can help you get started on treatment—which can help you reduce symptoms, prevent migraine episodes from occurring, and improve your overall quality of life.