Migraine Diagnosis & Categorization
On this page, we answer these questions:
What is the criteria for a migraine diagnosis?
What are some tips for navigating the diagnostic process?
What are the diagnostic categories of migraine?
Why get a diagnosis?
When you have migraine symptoms, it is a good idea to speak with a healthcare provider for a diagnosis.
This is not always straightforward. Migraines cannot be spotted in imaging (MRI, CT scan, etc.), and classifications and treatments are not always well understood by healthcare professionals in Canada.
Nevertheless, diagnosis is an important step towards treatment and relief for many Canadians. On this page, you’ll learn more about what to expect from the diagnostic process, and the different migraine categories that may be discussed along the way.
Step one: Getting a migraine diagnosis
Healthcare providers and researchers use the International Headache Disorders Classification to determine whether someone has migraine. The criteria are determined by experts and researchers based on experience and studies on big groups:
There is currently NO blood work or imaging test that can prove that you have migraine. The diagnosis is based on symptoms and making sure that there is no other cause for the headache (the SNOOPPPP red flags)
Typical symptoms used to diagnose migraine are:
- Recurrent attacks: migraine-like headaches will feel similar and happen repeatedly.
- Duration of attacks: 4 hours to 3 days
- Type of headache: typically one-sided, moderate to severe, and throbbing, but not everyone fits those criteria.
- Other symptoms: there is a big focus on nausea, light and sound sensitivity, but other symptoms like smell sensitivity, neck pain, difficulty to focus and dizziness are often part of an attack.
- Once you have received a diagnosis of migraine, you will have to define the situation more precisely to choose the right treatment.
TIPS WHEN SEEKING A DIAGNOSIS:
- Learn about the symptoms of migraine from reliable sources like the Migraine Canada website.
- Observe your own attacks carefully so that you can see if they fit with a migraine diagnosis, and so you can describe them well to your doctor.
- Keep a migraine diary that tracks migraine symptoms, duration, and frequency. Bring it to every appointment.
- Migraine is not always well understood by family physicians, so it is ideal to ask for a referral to a specialist where possible.
- If you have a new type of headache, know that it could be something other than migraine and seek medical advice
Step two: Defining the situation using migraine categories
Migraine can be categorized in the following ways. These categories help health professionals understand and communicate your specific situation, as well as determining possible treatments.
Migraine categorized by frequency·
- Episodic migraine: when you have less than 15 days per month of migraine/headaches.
- Frequent episodic: a category still in definition, it describes people who are not chronic but have migraine (often), like 7 to 14 days per month.
- Chronic migraine: the most severe form of migraine, if you have 15 days or more of headache per month, including 8 days with migraine symptoms.
Remember that migraine frequency fluctuates, and we know now that many patients may have a very bad month in the “chronic” category, and then go back down to episodic. We call this the roller coaster of migraine. While it may be important for research to create categories, remember that real life is more complicated! This is why keeping a migraine diary to track these ebbs and flows can be so important.
Read more:
Migraine categorized by symptoms
The symptom of aura is often used in migraine categorization, as we understand quite a lot about aura and this subgroup of patients has been well studied. Migraine with aura is the official term used for those who experience this symptom, and there are various other categories depending on the type of aura one experiences:
- Typical visual aura: any visual symptom with typical characteristics.
- Complex aura: problems with speech and sensation (numbness or tingling). This will often make your physician nervous and justify a workup.
- Hemiplegic migraine: the presence of auras with true weakness of a limb AND also other typical auras. There should always be a full workup and ideally genetic testing.
What if I have auras, but no headache? It is not uncommon to see a 40-60-year-old person having a very typical migraine aura with NO headache and no history of migraine. This should remind us that the aura and the migraine have different brain mechanisms and that the aura may occur without any headache.
Vestibular migraine: This is a very disagreeable combination of migraine, dizziness and vertigo (vestibular symptoms). This is still a controversial entity, and a lot of research is ongoing.
Read more:
Migraine categorized by triggers
The Classification does not endorse many official categories by triggers, even if these are frequently used by the public. For example, “sinus migraines,” “weather migraines” and “neck migraines” make sense to people but are not official categories.
Migraine researchers tend to see migraine as a disorder of the brain and argue that if we start diagnosing by triggers, we’ll end up with too many categories. There is one exception to this rule, which is menstrual migraine.
- Menstrual migraine: if migraine occurs reliably over the -2 to +3 days of bleeding, then this could be your diagnosis. Remember that if you have frequent or chronic migraine, overlap with the period might be random and that you should start with overall migraine control before using specific menstrual migraine techniques.
Migraine based on treatment response and severity (refractory migraine)
- Refractory migraine: Refractory means that treatments do not work. We often link it with chronic migraine, but episodic migraine could also be refractory. There is no official agreement for its definition, but usually, 2 to 4 recognized preventive treatments have to be ineffective to use this term. In general, refractory migraine is also severe and disabling.
- Chronic migraine categorized with or without medication overuse: The topic of medication overuse is a difficult one. Sadly, people with migraine tend to worsen if they use acute treatments frequently (even with no addiction). For this reason, big database research gives us the official cutoffs to prevent overuse – 10 days a month for opioid, triptans, any combination of medications and/or 15 days a month for acetaminophen or NSAIDs.
What about children?
- Abdominal migraine
- Cyclical vomiting syndrome
- Paroxysmal vertigo
- Paroxysmal torticollis
- Colics
For more information, visit our page on children and migraine.
Step three: Exploring treatment options
The purpose of a diagnosis, ultimately, is to get more help with the relief and management of migraine symptoms. Migraine is not curable, but it is treatable, and an official diagnosis opens doors to therapies, treatments, and procedures. These options can be used to prevent attacks or provide relief from pain and symptoms when attacks arise.
More resources on Migraine Categories
Chronic Migraine: Basic Facts
Chronic migraine can be a challenging and debilitating condition, affecting daily life and well-being. Proper diagnosis, understanding symptoms, and recognizing risk factors are key to effective...
Vestibular Migraine
Vestibular migraine is a complex and often misunderstood condition, blending migraine symptoms with vertigo and dizziness. In this detailed account, we'll explore David’s story to illustrate the...
Medication Overuse Headache
In this post, we delve into the complexities of Medication Overuse Headache. Often triggered by frequent medication use, this condition significantly impacts those living with chronic migraine....
Refractory Chronic Migraine: Support & Encouragement
From enduring countless specialists and treatments to navigating emotional challenges, individuals with chronic migraine showcase unwavering determination for relief. Explore expert insights on...
This Is Not My Normal Headache—Should I Worry?
Headache is an extremely common symptom that can be caused by migraine, but also tumours, infections, and other illnesses There are more than 200 causes of headache in the International...
Hemiplegic Migraine: Paralysis with Migraine
In this post, we explore hemiplegic migraine, where migraine symptoms intertwine with temporary paralysis, resembling stroke-like effects. Joan's firsthand experience highlights the sudden onset and...
Migraine with Aura: An Overview
Migraine with aura is a unique and often perplexing condition that affects many individuals, including Shelly, whose experiences offer a glimpse into the complexities of this neurological...
Cluster Headache – All You Need to Know
Explore the complexities of cluster headaches with Migraine Canada's enlightening webinar, featuring Dr. William Kingston, a distinguished neurologist and headache specialist. This session unravels...
Perimenopause and Migraine
Welcome to our enlightening video, "Perimenopause and Migraine," featuring Dr. Candice Todd, MSc, MD, FRCPC. In this comprehensive session, Dr. Todd discusses the intricate relationship between...
Migraine Awareness Webinar
Join Dr. Leroux, a distinguished neurologist specializing in headache and migraine, as she delves into preventive medicine strategies, patient support programs (PSPs), and access issues in this...
Debunking the myths on types of headache diagnosis
Welcome to an insightful exploration of migraine with Dr. Elizabeth Leroux, a neurologist and headache specialist known for her expertise and advocacy in migraine medicine. Join us as Dr. Leroux...
Hormones and Migraine – What’s The Connection?
Explore the intricate relationship between hormones and migraine with Dr. Candice Todd, a renowned general neurologist and headache medicine specialist at the Scarborough Health Network in Toronto,...
Struggling to access migraine care in Canada? You are not alone.
Migraine is not always a well-understood disease, even in the medical community. Many Canadians encounter barriers to care when seeking treatment for their migraine symptoms – from getting an accurate diagnosis, to accessing specialists, to identifying treatments, there can be many hurdles along the way
It doesn’t have to be that way.
At Migraine Canada, we advocate for better migraine care in Canada. By reaching out to the medical community, policymakers, and everyday Canadians, we are working to build a better future for those living with this disease.