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Migraine is most often diagnosed and treated by a neurologist – a specialist in disorders of the brain and nerves. However, many people with migraine go first to their primary care physician or family doctor for help.
There is no one test that is conclusive for a diagnosis of migraine. Migraine is generally diagnosed through a combination of a medical history and physical and neurological examinations. Blood tests, imaging scans, or a lumbar puncture may help rule out conditions with similar symptoms. The neurologist carefully considers the evidence before concluding that migraine is the correct diagnosis or ruling it out.
You will be asked about the history of your symptoms. Provide as much detail as possible about the type of head pain you feel during a migraine, any other symptoms you experience, and the frequency and timing of attacks. It is helpful to keep a migraine diary to record migraine symptoms. The diary may show a clear pattern that helps identify migraine triggers. The doctor will likely ask about family history of headaches, since heredity is a major risk factor for developing migraine.
Depending on symptoms and frequency, criteria may point to a specific type of migraine.
The doctor will perform a physical and neurological exam. The doctor will carefully examine your eyes and reflexes for signs of nerve damage. You will be asked to move your arms and legs in specific ways to test for weakness or lack of coordination. The doctor will test for loss of sensation by touching various parts of your body with a vibrating tuning fork, or sharp or dull items. The neurological exam provides an objective assessment of signs and symptoms that may suggest migraine or another condition.
Imaging scans are not necessary to diagnose migraine in most cases. However, if the doctor suspects the symptoms may be caused by another condition, they may order imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) scans. Scans allow the doctor to check for evidence that symptoms might be caused by brain tumor, multiple sclerosis lesions, hemorrhages (bleeds), or stroke. Imaging scans are painless.
Although blood tests cannot show whether or not you have migraine, they can identify whether symptoms might be caused by toxins, a brain infection, or problems with your cardiovascular system (heart and blood vessels).
A lumbar puncture (LP) can be used to check for infection, bleeding, cancer, or inflammation in the brain. A lumbar puncture involves the doctor inserting a thin, hollow needle between two vertebrae in your back to collect a sample of cerebrospinal fluid (CSF). CSF bathes the brain and the spinal cord. LP can cause discomfort, and many people develop a headache after the procedure.
Migraines begin before age 40 in more than 90 percent of people. Some types of migraine are more common in children, while others are more common in older people.
What other conditions can resemble migraine?
The process of ruling out similar conditions is referred to as differential diagnosis. To list just a few, conditions that may resemble migraine include transient ischemic attack (TIA), seizure disorder, headache associated with head trauma, temporal arteritis (inflammation of the arteries that supply blood to the head and brain), brain infections, hypoglycemia (low blood sugar), hemorrhage (bleeding in the brain), and hydrocephalus (buildup of CSF in the brain).