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How Does a Doctor Diagnose a Migraine?

A migraine headache causes symptoms such as severe head pain and sensitivity to light, sound, or smells. In order to be diagnosed with migraines, your doctor may prescribe tests such as blood tests, imaging tests (X-rays, computerized tomography [CT] scan, magnetic resonance imaging [MRI] scan), or lumbar puncture.
A migraine headache causes symptoms such as severe head pain and sensitivity to light, sound, or smells. In order to be diagnosed with migraines, your doctor may prescribe tests such as blood tests, imaging tests (X-rays, computerized tomography [CT] scan, magnetic resonance imaging [MRI] scan), or lumbar puncture.

A migraine headache is a neurological condition in which patients experience severe head pain along with sensitivity to light, sound, or smells. It is not the same as a “regular” headache and it is treated differently.

Doctors diagnose migraine headaches based on a patient’s medical history and the description of symptoms. A physical examination may be done but usually it will not find anything out of the ordinary. A neurological examination is often performed to help rule out other causes of the symptoms.

Additional tests may also be used to help rule out other causes for the symptoms such as: 

What Are Symptoms of Migraines?

Symptoms of migraine usually occur in five phases: 

  • Prodrome: warnings before a migraine
    • Changed in mood
    • Slight changes in sensations such as an abnormal taste or smell
    • Fatigue
    • Muscle tension 
  • Aura: a visual disturbance that precedes the headache phase
    • Geometric patterns or flashing, colorful lights
    • Blind spots (scotomas)
    • Loss of vision on one side (hemianopsia)
  • Headache: may last 4 to 72 hours
    • Usually occurs on one side of the head, though can occur on both sides
    • Throbbing pain 
    • Nausea
    • Vomiting
    • Sensitivity to light (photophobia) and sound (phonophobia)
  • Headache termination
    • Pain usually goes away with sleep even if the migraine is not treated
  • Postdrome: some signs may remain after the pain subsides
    • Inability to eat
    • Problems with concentration
    • Fatigue

What Is the Treatment for Migraines?

Treatment for migraine headaches includes: 

  • Non-medical treatments
    • Hydration
    • Ice 
    • Heat
    • A dark room/covering your eyes
    • Deep breathing
    • Rest
    • Massage
    • Biofeedback
  • Avoiding known triggers
    • Common migraine triggers include:
      • Stress
      • Anxiety
      • Anger
      • Poor sleep
      • Fatigue
      • Withdrawal from caffeine
      • Hunger/skipping meals
      • Certain foods and drinks, such as chocolate, processed foods with monosodium glutamate (MSG), and alcohol
      • Exposure to smoke
      • Bright lights
      • Certain smells
  • Pain relievers (analgesics)
    • Aspirin 
    • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
    • Acetaminophen (Tylenol)
    • Pain relievers that contain caffeine tend to work best
  • Other medications
    • Triptans
    • Trigger point injections
    • OnabotulinumtoxinA (Botox)
  • Anti-nausea medications (antiemetics)
    • Chlorpromazine, droperidol, prochlorperazine, and diphenhydramine
  • Selective serotonin 1F receptor agonist
    • Lasmiditan (Reyvow)
  • Calcitonin-gene related peptide (CGRP) antagonists
    • Rimegepant (Nurtec)
    • Ubrogepant (Ubrelvy)
  • Ergotamine preparations
    • Dihydroergotamine (D.H.E. 45, Migranal)
    • Ergotamine (Ergomar)
  • Neuromodulation
    • Transcutaneous supraorbital nerve stimulation 
    • Transcranial magnetic stimulation (TMS) 
    • Remote electrical neuromodulation 
    • Noninvasive vagus nerve stimulation (nVNS) 
  • Peripheral nerve blocks
    • Occipital nerve blocks 
    • Sphenopalatine ganglion blocks 

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References
https://americanmigrainefoundation.org/resource-library/what-is-migraine/

https://www.uptodate.com/contents/migraines-in-adults-beyond-the-basics?search=migraine&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults?search=headache%20treatment&source=search_result&selectedTitle=7~150&usage_type=default&display_rank=7

https://www.migraineagain.com/how-to-get-rid-of-a-migraine-fast/