Recognizing migraine headaches

In this video, you will learn how to avoid misdiagnosing your patient's migraine headache by using ICHD-3 criteria.

Robert Coni, DO EdS
Robert Coni, DO EdS
10th Aug 2020 • 3m read

Migraine headaches may seem easy to diagnose, but even the most experienced clinician can miss some of the trickier cases. In this video, we'll cover the criteria for diagnosing migraine headaches (with or without aura), common migraine triggers, the hidden aura symptoms that can be tricky to recognize, and when you should consider ordering genetic testing.

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Our Headaches Masterclass course outlines an approach that will guide your evaluation of patients with headaches. This course provides you with the knowledge and skills you need to recognize and categorize primary headaches accurately, the warning signs of ominous headaches (and those caused by medical conditions), and will teach you how to help your patients to help themselves by recognizing their triggers and adopting lifestyle changes.

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Video transcript

Migraine headache has been recognized for thousands of years. Early descriptions date to the first century A.D. Migraine is a complex neurophysiological disease characterized by episodic and sometimes chronic and progressive forms of headache. There are associated neurologic and non-neurologic symptoms that accompany the head pain.

Note that the International Headache Society Classification for Migraine includes migraine without aura, with aura, chronic migraine and associated migraine complications. Additionally, there are separate categories for gastrointestinal symptoms and vertigo which can be associated with migraine.

Basic diagnostic criteria for all migraine types includes: The headache attacks will last 4 to 72 hours when untreated or unsuccessfully treated . The headache has at least two of the following four characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, pain will be aggravated by routine physical activity such as walking or climbing stairs.

Or the migraine sufferer will avoid these activities. During a migraine headache at least one of the following is present: nausea and vomiting , photophobia, and phonophobia . Finally, to make the diagnosis, there should be at least five attacks fulfilling the above criteria. All International Classification of Headache Disorders Criteria always include a statement that the syndrome is not better accounted for by any other diagnosis.

The criteria for migraine with aura includes all of the migraine criteria mentioned previously, but there must be at least two attacks that have aura. Aura may include any of the following, fully reversible, aura symptoms, visual changes - which might include spots, clouded fields, flashes of light or scintillations. Sensory symptoms such as numbness or pins and needles.

Speech and language dysfunction. Motor power loss . Brainstem dysfunction such as diplopia, dizziness, or facial sensory changes . These aura symptoms must have at least three of the following six characteristics: at least one aura symptom spreads gradually over about 5 minutes, two or more aura symptoms occur in succession , each individual aura symptom lasts 5-60 minute, at least one aura symptom is unilateral, at least one aura symptom is positive, meaning an added sensory perceptive phenomena.

For example, scintillating lights or pins and needles paresthesia .The aura is accompanied, or followed within 60 minutes, by a headache . Migraine has a female to male gender ratio of approximately 3 to 1. There are many comorbid conditions with migraine including depression, anxiety, sleep disorders and obsessive-compulsive disorder.

There may be a genetic predisposition to migraine. Those predisposed typically can identify trigger mechanisms including foods, weather changes, fasting, sleep disturbances, stress and hormonal fluctuation. There are also migraines which provoke neurologic dysfunction known as complicated migraines.

One example is a form of migraine called hemiplegic migraine which will produce neurologic dysfunction, appearing as stroke-like symptoms on one side of the body. These events run-in families and testing can be done to determine if genetic HLA types associated with the syndrome are present. In the next Medmastery lesson, we’ll review the four stages of a migraine headache.

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