How Is Migraine Diagnosed?

There is no one sole examination that tests for migraine, so providers can use a combination of tests to detect migraine and help you figure out a treatment plan. Migraine is a neurological condition that causes painful symptoms such as head pain, nausea, and noise and light sensitivity.

Migraine is often underdiagnosed, so it's important to know the symptoms and visit a healthcare provider if you think you're experiencing migraine. During your appointment, a provider will 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

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

Keeping a headache journal can be beneficial for this part of the diagnostic process. 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, a 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 (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? 

Physical Exam

During your physical exam, a provider will usually:

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

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

Neurological Exams

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

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

• Cognitive function: The 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.
• Eye movements: It's common for a provider to examine your eyes to look for inflammation, redness, or damage, which can signal an increase in pressure in your brain.
• Motor strength test: This test helps a provider look for signs of muscle weakness, tenderness, and range of motion in your limbs and joints.
  
• 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 provide the healthcare provider with further information about your nervous and muscular systems. To do this, they 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, a provider may test your sense of touch. They may examine how your body responds to heat, cold, and pain sensitivity. 
  

Imaging Tests

A provider can generally use your medical history and physical exams to diagnose your migraine. Imaging tests are not typically necessary for migraine, but similar to a neurological exam, imaging tests can detect various brain conditions. The 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 cross-sections of the brain. This test can spot tumors, bleeding, and strokes.
• Magnetic resonance imaging (MRI): An MRI uses magnetic waves to create a detailed model of your brain. This scan takes longer than a CT scan but 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.

A 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. The provider will use the following diagnostic criteria to give you an official diagnosis of migraine:

A Quick Review 

While there is no single test for migraines, healthcare providers 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 a 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. 

It's good practice to contact a healthcare provider for proper testing if you begin to experience symptoms of migraine or have active migraine episodes. It's also a good idea to see your healthcare provider if your headaches are getting more severe or more frequent, are different than your usual headaches, or are accompanied by weakness or difficulty speaking.

Getting evaluated can help you start treatment, which can help you reduce symptoms, prevent migraine episodes from occurring, and improve your overall quality of life.