Diagnosing migraines is a tricky business. Migraines share symptoms with other illnesses, sometimes severe ones. While you might hear people call all severe headaches migraines or think you suffer from them yourself, it is critical to get an accurate diagnosis from a healthcare provider who can differentiate between migraines and other disorders. Here is what you need to know about self-diagnosing: we don’t recommend it. If you suspect you suffer from migraines or have repeated bouts of head pain and other symptoms, don’t hesitate to make an appointment with a primary care provider. If the pain and symptoms are painful or scary enough, go to the emergency room. It's always better to be safe than sorry.

How Doctors Diagnose Migraines

Unfortunately, there is no simple test for migraines. The doctor must get information from multiple sources to help narrow down the cause of your head pain and any other symptoms you suffer.

One of the things the doctor wants to rule out is stroke since it requires immediate care for the best outcome.

Your healthcare provider relies on several diagnostic practices to weed out other potential problems and arrive at the correct diagnosis, including:

• A thorough patient history
• A thorough physical examination
• Blood tests like a complete blood count, blood chemistries, and thyroid tests
• EKG and EEG measurements
• Spinal tap
• Imaging such as CT scan, MRI, or angiogram
• Psychological evaluation and neurological assessment

Blood and Spinal Fluid

A complete blood count (CBC) tells the physician if you are anemic (have a low red cell count or hemoglobin) or have an infection if the white cell count is high. A blood count can even show some types of cancer, such as leukemia and lymphoma. 

Blood chemistries tell the provider how your organs are performing. This test can show liver abnormalities, kidney failure, and other issues. Thyroid disease can cause fatigue and headaches that seem like migraines. 

A spinal tap (lumbar puncture) lets the physician see if there is anything unexpected in your spinal fluid. For example, the presence of white cells could indicate an infection of the brain or spinal cord.

Electrical Measurements

An EEG or electroencephalogram detects alterations in your brain’s electrical activity. Those alterations can show the difference between a migraine and changes in consciousness that may not be apparent from a physical examination and history.

Heart problems can also cause fatigue, dizziness, and headaches. An EKG shows the electrical activity of your heart, including any deviations that expose heart problems.

Imaging

To rule out strokes and blood vessel problems, you may have a CT scan, an MRI, or an angiogram to narrow the diagnosis. A CT scan and MRI show bleeding and blockages in the brain while an angiogram visualizes blood vessels. 

Your physician may not need to employ all of these examinations and tests, but there is no single one that will provide the answer. The doctor brings together the results to make a differential diagnosis of migraines and non-migraine illnesses.

The information may also tell them what variant of migraine is troubling you.

Historical data helps diagnose migraines. Your doctor might ask you to keep a diary in which you document the frequency and severity of your headaches, the type and location of the head pain, what you were eating before the attack, and a record of your sleeping habits. 

You may be asked to track everything you eat over several days, the exercise you get, and whether you are under stress. All of these things can create conditions for a migraine.

They look at family history of headaches and migraines, and they need to know how your migraines impact your daily life. 

Symptoms

People who suffer from migraines often have other symptoms besides head pain, including:

• Fatigue, sleepiness, and low energy
• Nausea and vomiting
• Dizziness, photophobia, or phonophobia
• Irritability or sadness

The doctor also looks for potential triggers for migraine, including certain foods, hormonal changes, sleep patterns, and dehydration.

How often do you have head pain, and where is it located? How badly does your head hurt? Do you have any symptoms in between headaches or right before an attack? How long does the headache last?

All these questions help your healthcare provider or migraine specialist make an accurate diagnosis. Without an accurate diagnosis, effective treatment may be impossible to determine.

Experiencing a migraine can bring about sensitivity to light or sound. Other symptoms people manifest include optical deviations. Their eyes don’t work together, or they see auras, twinkling lights, or other visual disturbances. Sound can make the head pain worse if it’s loud, high-pitched, or causes other vibrations.

Take notice of any changes in your symptoms if you think you have been suffering migraines. Symptoms can be worse during hormonal changes and at different stages of your life. If you notice a different pattern, bring it up to the doctor.

Migraine Variants

Once you have a migraine diagnosis, the doctor can tell if you have a specific type of migraine.

• Complicated migraine sometimes accompanied by an aura and may cause stroke-like symptoms
• Vestibular migraines that cause severe dizziness or vertigo 
• Cluster headaches that cause eye pain

The doctor will differentiate between a migraine and a non-migraine illness like tension headaches, medication rebound headaches, and serious problems such as stroke, TIA, seizures, an aneurysm, meningitis, encephalitis, concussion, and other disease states that have overlapping symptoms with migraine.

Trust and Communication

If you want to get to the heart of the matter, you need to trust your healthcare provider and tell them the truth about your medical history. In turn, your doctor should clearly communicate with you about various tests, diagnoses, and treatment plans. 

If you don’t understand, ask. There is nothing wrong with needing some translation to help you with the medical language. Both you and your doctor benefit from trust and clear communication to obtain the proper diagnosis and provide the best treatment.

A migraine diagnosis is a complex undertaking, and you see the physician repeatedly over months or years. It would be best if you had someone you can trust and understand so you can build a relationship that ensures you know the real problem and how to treat it.