The diagnosis of migraine primarily relies on clinical evaluation and medical history analysis, as there are currently no specific biological markers that can directly confirm the diagnosis. Physicians use systematic questioning and symptom descriptions to exclude other possible conditions and assess according to the diagnostic criteria set by the International Headache Society. Early and accurate diagnosis can help patients develop management plans promptly and prevent symptom progression.
The diagnostic process is usually divided into three stages: initial screening to identify possible headache types, detailed analysis of symptoms and lifestyle factors, and finally, necessary examinations to rule out other serious diseases. Patients should prepare information such as past symptom records, medication history, and family medical history to improve diagnostic efficiency.
Clinical assessment is the core of migraine diagnosis. Physicians systematically inquire about the nature and pattern of symptoms, including headache frequency, duration, location, and intensity. Key questions include whether there are typical accompanying symptoms such as nausea, vomiting, photophobia (light sensitivity), or phonophobia (sound sensitivity). For example, if visual phenomena like flickering lights or visual disturbances (aura symptoms) occur alongside headache, it may meet the criteria for migraine with aura.
Doctors will evaluate the impact of symptoms on daily life, such as whether they reduce activity levels or impair occupational function. A family history investigation is indispensable, as genetic predisposition is a significant risk factor for migraine. During history collection, it is important to distinguish triggers such as specific foods, stress, changes in sleep patterns, or hormonal fluctuations.
Although migraine itself is not an organic lesion, imaging examinations are necessary to exclude other serious causes when needed. Computed tomography (CT) or magnetic resonance imaging (MRI) can check for structural abnormalities in the brain, such as tumors or vascular anomalies. Blood tests are used to exclude infections, metabolic abnormalities, or endocrine disorders.
Neurological examinations assess reflexes, muscle strength, and sensory functions to confirm whether there are signs of nervous system damage. In special cases, such as sudden worsening of headache or accompanying consciousness disturbances, cerebrospinal fluid analysis or cerebral angiography may be required. Although these tests are not direct diagnostic tools for migraine, they effectively rule out urgent central nervous system diseases.
The International Classification of Headache Disorders (ICHD-3) is the core standard for diagnosing migraine. Physicians determine whether the patient's symptoms and attack frequency meet the criteria for "migraine." For example, ICHD-3 defines migraine without aura as requiring at least five headache episodes with specific timing and symptom combinations.
Auxiliary tools such as headache diaries help track symptom patterns, triggers, and severity. The MIDAS (Migraine Disability Assessment Scale) evaluates the impact of headaches on work, family, and social activities. These tools help physicians objectively quantify symptoms and develop personalized treatment plans.
Differential diagnosis involves excluding other conditions that may cause similar symptoms. For example, tension-type headache typically presents as bilateral pressure or tightness without the pulsating pain and sensitivity symptoms characteristic of migraine. Intracranial hemorrhage or tumors may be accompanied by neurological deficits and require imaging for confirmation. Cervical spine issues or temporomandibular joint disorders can also cause head discomfort and should be distinguished through physical examination.
Other diseases to differentiate from migraine include intracranial arteritis, headache related to endometriosis, and medication overuse headache. The physician will analyze based on the acuity, pain features, and disease course. For instance, sudden severe headache with fever may suggest meningitis or other infectious diseases.
Early diagnosis can prevent unnecessary examinations and treatment delays. Confirming the migraine type early allows patients to receive targeted relief and preventive treatments, reducing the frequency of acute attacks. For example, chronic migraine patients who do not receive early preventive medication may gradually develop daily headaches, increasing treatment difficulty.
For patients, a clear diagnosis can reduce psychological stress and avoid waste of medical resources. Physicians can also provide lifestyle modification advice, such as stress management, regular routines, and trigger avoidance strategies. Long-term follow-up shows that early-diagnosed patients have fewer emergency visits related to headaches, with an overall improvement in quality of life by approximately 30-40%.
Doctors first evaluate the patient's headache characteristics through history-taking, including pain intensity, duration, and associated symptoms (such as nausea and photophobia). When necessary, brain MRI or CT scans are arranged to exclude organic problems like tumors or vascular abnormalities, but these imaging tests are not required for all patients.
How can migraine be distinguished from general tension headaches?Migraines are often accompanied by pulsating pain, nausea, or sensitivity to light and sound, whereas tension headaches are usually characterized by pressing or tight sensations without autonomic symptoms. Physicians analyze symptoms' duration and frequency based on the International Headache Classification (ICHD) standards to differentiate.
Is it necessary to keep a headache diary for diagnosing migraine?Yes. Physicians often recommend patients to record the timing of attacks, triggers (such as diet and stress), symptom changes, and medication responses. This helps confirm the diagnosis and develop personalized treatment plans, especially for atypical symptoms.
What special symptoms warrant brain imaging examinations?If the headache suddenly becomes severe (like a "thunderclap headache"), is accompanied by neurological abnormalities (such as limb weakness), occurs for the first time after age 50, or if there is a history of cancer or immune system diseases, physicians will prioritize MRI or CT scans to exclude other serious causes.
Is blood testing necessary for diagnosing migraine?Routine blood tests are generally not required. However, if the headache pattern changes suddenly, or if there is unexplained fever or weight loss, physicians may order blood tests to exclude infections, autoimmune diseases, or metabolic disorders.
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