Migraine Diagnosis and Treatment

Diagnosing migraines

If you think you have migraine headaches, you’ll want to see a neurologist or another health care provider who can check your symptoms and medical history. There’s no specific test that can diagnose migraines. Your doctor will consider factors such as:

• Medical history: Your doctor will want to know how often you have headaches, what they feel like, what other symptoms you have and whether you’ve noticed any triggers or patterns. They may ask whether you have a family history of migraines.
• Symptoms: Your doctor will ask where you feel the pain, how intense it is, how long it lasts and whether you noticed symptoms like sensitivity to light or sound, nausea or aura.
• Physical examination: This exam can help rule out other possible causes of headaches.
• Other conditions: Your doctor will consider if you have other health problems that may be causing your headaches or adding to your symptoms.
• Finding the diagnosis: Your doctor will also ask other questions like how long the headache lasts, what the pain feels like and what other symptoms you have. With this information, they can decide if you have a specific type of migraine such as chronic migraine, hemiplegic migraine or vestibular migraine, or if it could be a different condition.

Testing

Even though no test can diagnose migraines, your provider may suggest certain tests or imaging studies to rule out other conditions or identify issues that might contribute to your headaches. Your doctor may recommend:

• Imaging studies (such as magnetic resonance imaging (MRI) or computed tomography (CT) scans) to check brain structure and rule out any underlying causes of the headaches. MRI can show abnormalities, tumors, vein or artery issues and other conditions. CT scans can help detect bleeding, tumors or brain structure issues.
• Sleep studies (polysomnography), to find out if sleep disorders such as sleep apnea could be adding to your headaches. 
• Blood tests, which can look for inflammatory markers, hormonal imbalances, vitamin deficiencies and thyroid function issues.
• Lumbar puncture (spinal tap) to analyze the cerebrospinal fluid for signs of infection, inflammation or other problems.
• Electroencephalogram (EEG), which measures the brain's electrical activity. EEG can also help diagnose seizures.
• Allergy testing, such as skin prick tests or blood tests, to see if allergies might be triggering your headaches.

Managing and treating migraines

Most people find that combining strategies works best to lower the frequency, duration and intensity of migraine attacks. These techniques can also help other symptoms that come with migraines. You and your health care provider may want to consider:

• Lifestyle modifications such as improving your sleep, managing stress and avoiding triggers.
• Medications, including over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs – like Advil/Motrin, Aleve or Excedrin) or prescription medications such as triptans, ergot derivatives or combination medications.
• Other prescription medicines that can help prevent frequent or severe migraines, such as beta-blockers, antidepressants, antiepileptic drugs, certain blood pressure medications and newer prescription medications that are specifically for migraines.
• Rescue medications for rapid relief during an attack.
• Specially placed botulinum toxin (Botox) injections.
• Biofeedback.
• Relaxation or mind-body techniques.
• Physical therapy.
• Acupuncture.
• Keeping to a regular schedule for meals, exercise and sleep.
• Supplements like vitamin B2, coenzyme Q10, butterbur, feverfew or magnesium – but make sure you check with your provider before you start any herbal remedies.
• Trigger management.
• Support and education.

How to cope with migraines

The pain of a migraine headache can be overwhelming. When you’re experiencing one, it can help to:

• Rest in a quiet and dark place.
• Apply cold or warm compresses to your forehead or the back of your neck.
• Massage your scalp or rub your temples.
• Practice relaxation exercises.
• Take small sips of water to stay hydrated.

Dealing with migraines can feel overwhelming. It can help to educate your family and friends about migraines so they understand what you’re going through and can help you when they happen. Building a support system can help you cope.

These resources can provide more information:

• American Migraine Foundation
• National Headache Foundation
• MedlinePlus
• National Institute of Neurological Disorders and Stroke
• American Academy of Family Physicians

While you may never get rid of your migraines completely, you can take steps to make them shorter, less frequent and less intense. By working closely with a health care provider, you can create a treatment plan that works for you.