Diagnostics

Migraine is a clinical diagnosis based on history and physical examination. The most important step is to exclude red flags for headache that suggest a secondary headache (e.g., infection, hemorrhage, intracranial mass) and require more exhaustive investigation (e.g., imaging). Suspect a primary headache when no red flags are identified, and confirm the diagnosis using the diagnostic criteria for migraine. [9][12]

Migraine is a clinical diagnosis that is based on patient history and physical examination.

• Not routinely indicated

• Consider a urine pregnancy test to guide pharmacotherapy choices in women of childbearing age.

Neurological imaging is not routinely indicated for uncomplicated migraine.

• Indications

  • Clinical features suggest a secondary headache (see “Red flags for headache” and “High-risk headache”).

  • Migraine with the following characteristics:

    • Unusual, prolonged, or persisting aura

    • First episode of brainstem aura, hemiplegic migraine, retinal migraine, aura without headache

    • Change in baseline migraine clinical features (frequency, severity, aura)

    • Consider in first migraine

• Procedure

  • MRI is preferred over CT (except in emergency settings if there is suspicion of a vascular hemorrhagic event).

  • See “Imaging for headaches.”

• Findings

  • Typically normal

  • Nonspecific white-matter changes may be seen

• Paroxysmal hemicrania

• Medication overuse headache