Migraine Diagnosis

Migraine Diagnosis: Headache is a very common condition. The vast majority of headache resolves without need to consult a doctor. In primary care, the most commonly encountered headache disorders are:

  • Migraine
  • Tension-type Headache
  • Chronic Daily Headache
  • Cluster Headache

These are all Primary Headache Disorders and account for almost all headache.

Only a tiny proportion of headache is secondary in nature i.e. due to a more serious underlying pathology. However, there are certain symptoms indicative of sinister headache that  GPs should watch out for that may need referral.

Eliminating Secondary headache

Warning signs that may indicate possible secondary headache:

  • Sudden onset: Patients with a subarachnoid haemorrhage typically report having a sudden onset of severe headache
  • The age of the patient: Temporal arthritis typically occurs in older people and is extremely rare in individuals younger than 50. Primary headache disorders usually begin at a much younger age
  • Associated symptoms: Fever and neck stiffness may indicate Bacterial meningitis or Herpes simplex encephalitis.  Mental deterioration, seizures, or weakness of the extremities or face may be symptoms of brain tumors.
  • Recent head trauma: Headaches soon after trauma to the head may be caused by subdural or epidural hematomas.
  • Worst headache
  • Triggered by coughing / sneezing
  • Repetitive / Long-lasting / Non-spreading aura
  • Papilloedema
  • Persistent headache in children
  • Occipital headache in association with uncontrolled hypertension
  • Signs or symptoms of ongoing neurological deficit between headaches

I.H.S Diagnostic Criteria

Once secondary headache has been ruled out, the next step is to make the correct diagnosis of primary headache. Headache diagnosis has been made easier by the International Headache Society (I.H.S.) Diagnostic guidelines, first published in 1988 and updated in 2004.

More From This Section:

Migraine
Diagnostic Resources

Diagnosing Migraine Migraine Diagnostic Questionnaire: 15 Key Questions GP Migraine Algorithm: The Treatment of Migraine Patient Treatment Plan IHS Classification of Headache Disorders  NICE Guidelines on...[read more]

Migraine
Diagnosing Migraine (I.H.S Criteria)

The International Headache Society (I.H.S) criteria for diagnosing Migraine are both inclusive (certain features must be present) and exclusive (secondary headaches must first be ruled out). The criteria are outlined below. Please note that none of...[read more]

Migraine
Tension-Type Headache

Tension-type headache is the most common type of primary headache with a lifetime prevalence of up to 78%. However, episodic tension-type headache requires little intervention from medical professionals as it rarely produces significant disability....[read more]

Migraine
Cluster Headache

Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head, usually around the eye. Cluster headaches can occur several times per day and...[read more]

Migraine
Chronic Daily Headache

Chronic daily headache (CDH) is a descriptive term rather than a specific diagnosis. It can evolve from any primary headache disorder or can be de novo. Studies in the US and Europe indicate that 4-5% of the general population are affected by CDH....[read more]

Migraine Diagnosis

Migraine Diagnosis: Headache is a very common condition. The vast majority of headache resolves without need to consult a doctor. In primary care, the most commonly encountered headache disorders are:

  • Migraine
  • Tension-type Headache
  • Chronic Daily Headache
  • Cluster Headache

These are all Primary Headache Disorders and account for almost all headache.

Only a tiny proportion of headache is secondary in nature i.e. due to a more serious underlying pathology. However, there are certain symptoms indicative of sinister headache that  GPs should watch out for that may need referral.

Eliminating Secondary headache

Warning signs that may indicate possible secondary headache:

  • Sudden onset: Patients with a subarachnoid haemorrhage typically report having a sudden onset of severe headache
  • The age of the patient: Temporal arthritis typically occurs in older people and is extremely rare in individuals younger than 50. Primary headache disorders usually begin at a much younger age
  • Associated symptoms: Fever and neck stiffness may indicate Bacterial meningitis or Herpes simplex encephalitis.  Mental deterioration, seizures, or weakness of the extremities or face may be symptoms of brain tumors.
  • Recent head trauma: Headaches soon after trauma to the head may be caused by subdural or epidural hematomas.
  • Worst headache
  • Triggered by coughing / sneezing
  • Repetitive / Long-lasting / Non-spreading aura
  • Papilloedema
  • Persistent headache in children
  • Occipital headache in association with uncontrolled hypertension
  • Signs or symptoms of ongoing neurological deficit between headaches

I.H.S Diagnostic Criteria

Once secondary headache has been ruled out, the next step is to make the correct diagnosis of primary headache. Headache diagnosis has been made easier by the International Headache Society (I.H.S.) Diagnostic guidelines, first published in 1988 and updated in 2004.

More From This Section:

Migraine
Diagnostic Resources

Diagnosing Migraine Migraine Diagnostic Questionnaire: 15 Key Questions GP Migraine Algorithm: The Treatment of Migraine Patient Treatment Plan IHS Classification of Headache Disorders  NICE Guidelines on...[read more]

Migraine
Diagnosing Migraine (I.H.S Criteria)

The International Headache Society (I.H.S) criteria for diagnosing Migraine are both inclusive (certain features must be present) and exclusive (secondary headaches must first be ruled out). The criteria are outlined below. Please note that none of...[read more]

Migraine
Tension-Type Headache

Tension-type headache is the most common type of primary headache with a lifetime prevalence of up to 78%. However, episodic tension-type headache requires little intervention from medical professionals as it rarely produces significant disability....[read more]

Migraine
Cluster Headache

Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head, usually around the eye. Cluster headaches can occur several times per day and...[read more]

Migraine
Chronic Daily Headache

Chronic daily headache (CDH) is a descriptive term rather than a specific diagnosis. It can evolve from any primary headache disorder or can be de novo. Studies in the US and Europe indicate that 4-5% of the general population are affected by CDH....[read more]