Migraine – Diagnosis and Treatment

Diagnosis

Diagnosing migraine isn’t as simple as running a scan or checking blood work. You won’t see migraine show up on an MRI or CT scan—the trouble’s in how the brain functions, not how it looks.

The brain’s structure and blood vessels usually look normal. So, doctors lean on your health history, current symptoms, and a careful physical and neurological exam to figure out if you’re dealing with migraine.

A neurologist or headache specialist will usually ask about a few things:

• Headache Symptoms: When did they begin? How often do they come? How long do they last? What’s the pain like?
• Other Migraine Symptoms: Nausea, vomiting, and sensitivity to light or noise all matter.

• Auras or Visual Problems: Some people see flashing lights, zigzag lines, or lose part of their vision before or during the headache.

• Family History: If your relatives have migraines, your odds go up too.

• Triggers and Patterns: A headache diary can reveal links to hormones, foods, or stress.

Main Features of a Migraine Diagnosis

Feature	Examples
Headache Type	Pulsating or throbbing pain, often one-sided
Associated Symptoms	Nausea, vomiting, sensitivity to light/sound
Aura	Visual changes before headache
Frequency	Episodic (now and then) or chronic (often)
Family History	Relatives with migraines
Triggers	Stress, hormone shifts, certain foods

Symptoms Considered

Migraines are way more than just a bad headache. Doctors look for a mix of symptoms. Maybe you get throbbing pain on one side, or sometimes both.

Nausea and vomiting show up a lot, and bright lights or loud sounds can make you want to hide in a dark room.

Some individuals get visual warnings—bright spots, zigzags, or even brief vision loss—before the headache hits. That’s called aura.

Women sometimes notice migraines tied to their periods. If you get headaches most days each month, your doctor might call it chronic migraine, which needs extra attention.

Role of Medical Tests

Doctors don’t see migraine on scans, but they might order tests if your headache pattern seems strange, new, or worse than usual, or if your symptoms hint at something else. They want to rule out things like:

• Brain tumors
• Bleeding in the brain
• Nervous system infections
• Stroke
• Blood vessel or nerve damage

MRI (Magnetic Resonance Imaging)

This test uses magnets and radio waves to show detailed images of the brain and blood vessels. It can spot tumors, strokes, or blood flow issues.

CT (Computed Tomography) Scan

This test uses X-rays to take pictures of the brain. It’s good for finding bleeding, infections, or injuries.

If the scans look normal and your symptoms match migraine, doctors usually feel confident about the diagnosis.

Identifying the Type of Migraine

Doctors also try to pin down your specific migraine type. Main types include:

• Migraine without Aura: The most common kind. You get headaches, maybe nausea, and you’re sensitive to light or sound.

• Migraine with Aura: You get warning symptoms like visual changes before the pain.

• Chronic Migraine: Headaches on 15+ days a month, with migraine features at least 8 days.

• Menstrual Migraine: Linked to periods and hormone swings.

• Hemiplegic Migraine: Rare—causes temporary weakness on one side of the body, along with migraine.

Doctors use symptom diaries, screening tools, and interviews to figure out what kind and how often you get migraines.

Tools That Help in Diagnosis

A few tools really help nail down the diagnosis:

• Headache Diaries: Track how often headaches happen, what triggers them, and what helps or makes them worse.

• Migraine Screening Questionnaires: Short surveys to check for classic migraine signs.

• Patient History Forms: Listing past illnesses, injuries, and family history helps rule out other issues.

Keeping a headache diary helps you and your doctor spot patterns. Write down when headaches start, what symptoms show up first (like aura), and what makes things better or worse.

Keeping Track of Symptoms

If you get headaches, jot down all the details:

• Date and time of each headache
• How long it lasts
• Where you feel the pain
• How bad it feels (mild, moderate, severe)
• Any warning signs before it starts
• Triggers like food, stress, hormones, or poor sleep
• What treatments you tried and if they worked

This info guides both diagnosis and treatment planning.

Partnering With the Health Care Team

Work closely with your healthcare provider. They’ll help you understand the difference between migraine and other headaches, and answer your questions about causes, symptoms, and treatment.

If you do have migraine, your doctor will go over treatment options—whether you get them once in a while or almost every day. Staying informed, asking questions, and tracking your symptoms can really help you find a plan that works.

Treatment

Medications to Ease Migraine Pain

Lots of medicines can help control migraine pain and symptoms if you take them early—right when symptoms start.

Common Migraine Pain Medications

Type	How They Help	Possible Side Effects
Nonsteroidal anti-inflammatory drugs (NSAIDs)	Lessen headache pain and swelling	Upset stomach, ulcers, bleeding
Acetaminophen	Eases mild headache pain	Liver issues with high doses
Combination pain relievers	Ease mild migraine quickly	Medication overuse headache, stomach pain
Migraine-specific pain relievers	Block pain signals in the brain	Dizziness, chest tightness
Long-acting migraine reliever	Used for long-lasting migraines	Nausea, cramps, not for heart patients
Strong pain relievers	Rarely used—only if nothing else helps	Addiction, drowsiness
Anti-nausea medications	Stop migraine nausea and vomiting	Drowsiness, low blood pressure

• Migraine-specific pain relievers are a common choice for moderate to severe migraines. They come as pills, nasal sprays, or shots. They target the brain’s pain pathways. If you have heart or stroke risk, you’ll need to avoid these.

• NSAIDs like ibuprofen and naproxen are usually the first pick for mild or moderate headaches and are easy to get. Acetaminophen is another option, especially if you can’t use NSAIDs.

• Combination drugs—acetaminophen, aspirin, and caffeine—can stop mild migraines, but using them too often can trigger more headaches.

• Long-acting migraine reliever is for stubborn cases or headaches that last over 24 hours, but it’s not safe for everyone, especially people with heart disease.

• Anti-nausea drugs are often added if you get nausea or vomiting along with your migraine.

Some of these aren’t safe during pregnancy or breastfeeding—always check with your healthcare provider first.

Routes of Administration

You can take migraine meds in different ways:

• Oral tablets
• Nasal sprays
• Injections
• Dissolving wafers

Pick the route that works best for you—if you need fast relief or can’t keep pills down, talk to your doctor about other options.

First Steps and Guiding Principles

• Take medicine as soon as you feel a migraine coming on.
• Don’t overuse pain meds—this can actually make things worse or create new headaches.
• Track your triggers and patterns to find what helps most.

Medicines to Lower the Chance of Migraines

If you get migraines often—like several times a month—your doctor might suggest medicine to prevent them or make them less severe.

Common Preventive Medicines

Type	How They Work	Possible Side Effects
Beta-blockers	Lower blood pressure, steady nerves	Tiredness, low heart rate
Calcium channel blockers	Relax blood vessels, help some with aura	Constipation, dizziness
Antidepressants	Affect mood chemicals, reduce migraines	Sleepiness, dry mouth
Anti-seizure drugs	Calm nerve activity in the brain	Weight changes, dizziness
Calcitonin gene-related peptide (CGRP) monoclonal antibodies	Block a protein linked to migraine pain	Injection site pain, possible reactions
Botulinum toxin	Muscle-relaxing injections	Neck pain, swelling at injection site

Doctors usually suggest preventive therapy if:

• You get migraines more than four times a month.
• Attacks last a long time or don’t improve with usual meds.
• Migraines disrupt your school, work, or daily life.

How Preventive Medications Are Used

• Most are taken every day, even when you feel fine.
• You might need a few weeks to notice the full effect.
• Regular check-ins help track how well the medicine works and catch side effects.

Special Points About Common Medicines

• Beta-blockers are often a first choice, especially if you also have anxiety or high blood pressure.
• Tricyclic antidepressants help even if you’re not depressed—it works by changing brain chemicals.
• Anticonvulsants lower migraine frequency but aren’t safe if you’re pregnant or planning to be.
• CGRP monoclonal antibodies are shots you give yourself once a month or every few months.
• Botulinum toxin injections are given by your provider every 12 weeks for adults with frequent migraines.

Always talk about side effects, pregnancy plans, and your health with your provider before starting something new.

Daily Habits and At-Home Strategies

Simple changes at home can make a real difference for migraine. If pain starts, find a calm, dim room. Lying down, closing your eyes, or even a quick nap might help, especially with a cool towel or ice pack on your forehead.

Stay hydrated—drink water throughout the day. Dehydration can make headaches worse. Stick to regular sleep and meal times. Going to bed and waking up at the same time helps your sleep quality and may prevent attacks.

Eating meals on a schedule keeps your blood sugar steady, which can help too. Managing stress matters. Try deep breathing, meditation, or biofeedback to calm your mind.

Helpful Lifestyle Tips	Why They Help
Regular sleep schedule	Reduces risk of attacks
Consistent meal times	Prevents blood sugar drops
Daily hydration	Lowers chance of headache
Stress management techniques	Eases tension and anxiety
Tracking symptoms and triggers	Identifies personal patterns
Aerobic exercise	Improves mood, helps prevent migraines

Keeping a headache diary lets you spot patterns—maybe stress, caffeine, weather, or lack of sleep are your triggers. Jot down which meds you use, since overusing some can cause rebound headaches.

Physical activity like walking, swimming, or cycling may lower tension and cut migraine risk if you do it regularly. Warm up first, since sudden or intense exercise can sometimes trigger headaches.

Sticking with these routines may also boost your mood and help with sleep or depression.

Nontraditional Migraine Relief Methods

Lots of people try things outside of regular medicine to help their migraines. Some methods focus on how your body or mind handles stress. For example, acupuncture uses fine needles at certain points and can help some folks.

Biofeedback uses special machines to help you notice and control muscle tension. With practice, it might get easier to relax and keep migraine pain away.

Cognitive behavioral therapy (CBT) teaches new ways to think and act, which can change how pain feels. Some people find real relief with CBT.

Practices like meditation and yoga are popular for lowering stress. Since stress is a big migraine trigger, doing yoga or meditation often might cut down on migraine days and shorten attacks.

Some people also try certain supplements and herbs:

Option	Possible Benefit	Notes
Magnesium	Might help with prevention	Results are mixed
Riboflavin	May lower migraine frequency	High doses needed
Feverfew	Could reduce severity	Research is uncertain

Herbal remedies like feverfew are used by some, but research is mixed. High-dose riboflavin and magnesium might help lower how many migraines you get, but results vary.

Talk to your healthcare provider before trying these, especially if you’re pregnant or taking other meds.

Getting Ready for Your Visit

Steps You Can Take Before Your Appointment

Getting ready before seeing your doctor or headache specialist really helps. Here’s how to start:

• Track Your Migraines: Keep a headache diary. Write down when each headache starts, how long it lasts, what it feels like, any visual issues, and possible triggers.

• Note Important Details: List any big stresses or life changes that seem linked to your symptoms.

• List Your Medicines: Write down all meds, vitamins, and supplements you use, including how much and how often.

• Prepare Your Questions: Make a list of what you want to ask your doctor. This might be about causes, treatment, tests, or lifestyle changes.

Tip: Bring a friend or family member if you can—they might help you remember what’s discussed.

A table of useful questions for your doctor might look like this:

Questions to Ask
What might be causing my migraines?
Are tests needed?
Could my headaches be chronic or only happen at times?
What treatment options are there?
Should I change my diet or habits?
How do I manage migraines with my other health issues?

What Your Provider Will Likely Discuss

During your visit, your provider might ask:

• How often you get headaches and if there’s a pattern.
• How bad the symptoms are and how they affect your life.
• What helps and what makes things worse.
• Family history of migraines or headaches.
• Details from your headache diary or any notes you bring.

They might also ask about other health problems or meds you’re taking.