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Diagnosis of Migraine
The diagnosis of migraine headache is presented here as a subjective evaluation of subjective complaints. Is there objective confirmation?
Migraine Without Aura.
The diagnosis of migraine is established by obtaining a thorough history from the patient.1 There are no objective tests for migraines. Other neurological disorders, such as transient ischemic attack or mass lesion, should be excluded by the history, physical examination, and appropriate diagnostic testing. The diagnosis, in most cases, follows previously published criteria that describes a migraine (with and without aura) as follows:
Previously used terms: common migraine, hemicrania simplex. Description: Idiopathic, recurring headache disorder manifesting in attacks lasting 4 to 72 hours. Typical characteristics of headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, and association with nausea, photophobia, and phonophobia.
Migraine With Aura.
Previously used terms: classic migraine, classical migraine, ophthalmic, hemiparesthetic, hemiplegic or aphasic migraine, migraine accompagnee, complicated migraine. Description: Idiopathic, recurring disorder manifesting with attacks of neurological symptoms that can be unequivocally localized to the cerebral cortex or brain stem, usually gradually developing within 5 to 20 minutes and usually lasting less than 60 minutes. Headache, nausea, and/or photophobia usually follow neurological aura symptoms directly or after a free interval of less than 1 hour. The headache usually lasts 4 to 72 hours, but may be completely absent.
Seymour Diamond, MD
Chicago, Ill
1. Diamond S, Elkind A, Jackson RT, Ryan R, DeBussey S, Asghamejad M. Multiple-attack efficacy and tolerability of sumatriptan nasal spray in the treatment of a migraine. Arch Fam Med. 1998;7:234-240.
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Arch Fam Med. 1999;8:198.
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