Although some people use the term “migraine” interchangeably with “headache,” a migraine is more than that. It’s actually a neurological disease. A headache is usually one part of a migraine attack, which includes other bothersome symptoms, such as visual disturbances, nausea, and dizziness. If you regularly experience headaches and other symptoms of migraine, it may be time to seek a diagnosis. Your primary care doctor can usually evaluate your symptoms and decide what treatment will work best for you, but in some cases, you may be referred to a neurologist. Once you have a migraine diagnosis, you can begin the treatment you need.
If you have headaches more than four times a month and they’re impacting your quality of life, you should consider seeking a diagnosis and further treatment that is specific for migraine, she says. “Even for people who have more infrequent attacks, say once or twice a month, but they are debilitating, and they have to take the whole day off work or stay in bed all day, that person should seek a diagnosis and medical treatment for migraine,” says Dr. Kumar. “We have a lot of medications we can use — not only rescue medications when they have a headache, but also preventive medications to decrease the severity and frequency of their headaches,” she adds. If you’ve been managing your headaches with over-the-counter medications frequently (more than once or twice a week), you should talk with your doctor about your symptoms, she says. “Using these medications this frequently can set you up for what we call ‘rebound headaches,’ or medication-overuse headaches,” says Kumar. “You really want to avoid this, because it leads to more frequent headaches that are very difficult to treat.”
How to Prepare for a Doctor Appointment to Discuss Potential Migraine Symptoms
Make a complete list of your symptoms, including those that precede or follow a headache. Be sure to note whether you have nausea or sensitivity to light, sound, smell, or touch, but don’t leave out other symptoms because you think they’re unrelated.Pay attention to what your headache feels like, what kind of pain you’re experiencing, and where the pain is located.Note when your symptoms occur and how long they last.Note anything that relieves your symptoms.Tell your doctor whether you’ve noticed any patterns in your attacks, such as occurrence after a weather change, lack of sleep, or when you consume certain foods or drinks.Find out about your family history; most people with migraine have a relative with migraine, even if that person was never formally diagnosed. Ask whether any relatives have (or had) bad headaches that cause them to spend the day in a dark room, or other symptoms typically associated with migraine.
Do I Need to See a Neurologist or Headache Specialist for a Diagnosis?
After a discussion with your primary care provider, you may decide to see a headache specialist or a neurologist. Both are specially trained to treat head pain disorders, including migraines.
Your doctor will review your personal medical history, including any chronic illnesses you are managing or medications you take, and also ask you about migraine in your family. Your doctor will also ask about the severity and frequency of your symptoms and how they affect your daily life.
Symptoms of Migraine Necessary for a Diagnosis
Unilateral location (occurring on only one side)Pulsating or throbbing qualityAt least moderate severityAggravated by routine physical activity
At least one of the following symptoms should be present:
Nausea or vomitingPhotophobia (light sensitivity)Phonophobia (noise sensitivity)
When Is Additional Testing for Migraine Needed?
Certain signs and symptoms are considered “red flags” and not typical symptoms of headache or migraine. They don’t always indicate a serious medical issue, but they do need further investigation. Your doctor may order an MRI or another type of brain scan to rule out other possible causes, such as a brain tumor, aneurysm, or high pressure in the brain. Some of the rarer types of migraine, such as hemiplegic migraine or vestibular migraine, may require additional testing, because their symptoms can overlap with other conditions. Magnetic resonance imaging (MRI) Similar to a CT scan, an MRI can also produce detailed images of your brain and blood vessels to help your doctor diagnose any tumors, strokes, bleeding, infections, or other neurological conditions that may be causing symptoms. Lumbar puncture If your doctor suspects that your symptoms may be caused by an infection or neurological damage, you may be asked to undergo this procedure (sometimes called a spinal tap). In a lumbar puncture, your doctor will first sterilize the skin overlying two vertebrae (usually in your lumbar spine), then anesthetize the area with an injection of a local anesthetic. After that, the doctor will insert a thin needle into the space between the vertebrae to remove a sample of cerebrospinal fluid for laboratory analysis.
Is a Psychological Examination Necessary for Diagnosing Migraine?
A psychological evaluation isn’t necessary to get a diagnosis of migraine. But your healthcare provider may recommend that you get one because of the link between depression, anxiety, and migraine. In the meantime, depending on which symptoms you have, your care provider will develop a treatment plan for how best to manage your attacks.
