Migraine Management Essential #1 — Getting the Correct Diagnosis
We can't get appropriate treatment or know what we can do to help ourselves without an accurate diagnosis. Migraine isn't always an easy diagnosis. Many of the symptoms of Migraine can also be symptoms of other medical issues including stroke, TIA, tumor, and aneurysm. Since there are no diagnostic tests to confirm a diagnosis of Migraine, it's what's called a "diagnosis of exclusion." Migraine is diagnosed by:
reviewing the patient's medical history,
reviewing the patient's family medical history,
noting and discussing the patient's symptoms,
conducting necessary examinations, and
ruling out other causes for the patient's symptoms.
A simple diagnosis of Migraine is not complete. There are several different forms of Migraine, and knowing which form or forms we have can be important to choosing appropriate treatment options. Standardizing Migraine diagnoses simplifies matters by keeping everyone "on the same page." The gold standard for diagnosing Migraine and other Headache disorders is the International Headache Society's International Classification of Headache Disorders, Third edition (ICHD-3).
ICHD-3 recognizes the following forms of Migraine, syndromes that are common precursors of Migraine, and complications of Migraine:
1.1 Migraine without aura
1.2 Migraine with aura
1.2.1 Migraine with typical aura
220.127.116.11 Typical aura with headache
18.104.22.168 Typical aura without headache
1.2.2 Migraine with brainstem aura (formerly called basilar Migraine)
1.2.3 Hemiplegic Migraine
22.214.171.124 Familial hemiplegic Migraine
126.96.36.199 Sporadic hemiplegic migraine
1.2.4 Retinal Migraine
1.3 Chronic Migraine
1.4 Complications of Migraine
1.4.1 Status migrainosus
1.4.2 Persistent aura without infarction
1.4.3 Migrainous infarction
1.4.4 Migraine-triggered seizures
1.5 Probable migraine
1.6.1 Probable migraine without aura
1.6.2 Probable migraine with aura
1.6 Episodic syndromes that may be associated with Migraine
1.6.1 Recurrent gastrointestinal disturbance
1.3.2 Abdominal migraine
1.6.2 Benign paroxysmal vertigo
1.6.3 Benign paroxysmal torticollis
In the appendix of ICHD-3, there is also listed vestibular Migraine. The purpose of the appendix is to present
research criteria for a number of novel entities that have not been sufficiently validated by research conducted so far. In many cases, diagnoses listed in the appendix of the ICHD-3 will be moved into the main portion of the document as an "official" diagnosis in the next edition. This was the case with chronic Migraine, which was in the appendix of ICHD-2.
A note on chronic migraine. A diagnosis of chronic Migraine should also include the form or forms of Migraine. For example — chronic Migraine without aura, chronic familial hemiplegic Migraine, etc.
It's not at all uncommon to be diagnosed with more than one form of Migraine or with both Migraine and another headache disorder. For example:
It's unusual to experience aura with every Migraine, so most people who are diagnosed with Migraine with aura are also diagnosed with Migraine without aura.
Tension-type headache is very common, so it's not unusual to be diagnosed with one or more forms of Migraine and tension-type headache.
Quite a few people who have cluster headaches also have Migraine.
Diagnosing Migraine isn't always easy. Unfortunately, a high percentage of people with Migraine disease have to consult more than one doctor before being correctly diagnosed, often over a period of years. Remember that there's nothing wrong with getting a second opinion. If you're not confident in the diagnosis your doctor has given you, please don't hesitate to get that second opinion.