How to Diagnose Migraines?

Migraine is often misunderstood. Many people think diagnosing a migraine requires brain scans, blood tests, or extensive investigations. In reality, migraine is primarily a clinical diagnosis, meaning doctors identify it based on symptoms, patterns, and history rather than a single test. Importantly, migraine is not a brain tumour, stroke, or life-threatening disease, even though the pain can feel severe and frightening.

Doctors focus on listening to the patient’s experience. They look at how often headaches occur, how long they last, what the pain feels like, and what other symptoms accompany them. Most people with migraine have a normal neurological exam, meaning reflexes, muscle strength, coordination, and vision are unaffected. This is a strong sign that advanced imaging like MRI is usually unnecessary.

The International Classification of Headache Disorders (ICHD-3) is the global standard for diagnosing migraine. For migraine without aura, doctors look for:

• Headache attacks lasting 4–72 hours

• Pain that is one-sided, throbbing or pulsating, moderate to severe, and worsened by routine activity

• At least one associated symptom: nausea/vomiting, sensitivity to light, or sensitivity to sound

If these features occur repeatedly and cannot be explained by another condition, a migraine diagnosis becomes likely.

Routine MRI, CT scans, or blood tests do not confirm migraine. According to studies, these are unnecessary when symptoms fit diagnostic criteria and neurological exams are normal. Blood tests are only used if another underlying condition (like infection or hormonal imbalance) is suspected.

Doctors may order an MRI if there are warning signs, including:

• A new or rapidly worsening headache

• Headaches after age 50

• Headaches with seizures, weakness, or numbness

• Sudden “thunderclap” headaches reaching peak intensity in seconds

These red flags are uncommon but important to rule out serious conditions.

Migraines can be confused with tension or sinus headaches. Key differences:

• Migraine: Pulsating pain, worsens with movement, often with nausea or sensory sensitivity

• Tension headache: Tight band-like pain, lacks associated symptoms

• Sinus headache: Linked to infection and nasal symptoms

Correct identification prevents misdiagnosis and unnecessary treatments.

A headache diary is extremely useful. Recording frequency, duration, intensity, symptoms, triggers, and menstrual cycles for 4–6 weeks helps doctors identify patterns and make a confident diagnosis.

Triggers don’t cause migraine, but can provoke attacks in a sensitive brain. Common triggers include skipped meals, dehydration, irregular sleep, stress, hormonal changes, bright lights, strong smells, and certain foods. Doctors use this information to help patients manage their migraine, not to blame them.

Primary care physicians, neurologists, or headache specialists can diagnose migraine. Often, a trained general physician can do this based on history and criteria alone. Neurologist referral is usually reserved for unusual, severe, or treatment-resistant headaches.

Alongside lifestyle modifications and trigger management, some natural treatment options have gained attention for migraine relief. Cannabinoid-based medications, derived from compounds found in cannabis, are being studied for their potential to reduce migraine frequency and severity without the side effects of some conventional medications. These treatments work by interacting with the body’s endocannabinoid system, which plays a role in regulating pain, inflammation, and neurological signalling. 

Understanding that migraine is a neurological condition, not something dangerous, reduces anxiety and unnecessary tests. Early diagnosis helps patients make informed lifestyle choices, avoid repeated emergency visits, and manage their condition effectively.

Also Read:

• What is Migraine?

• Types of Migraine?

• Understand Migraine Symptoms and Causes for Better Prevention