How are migraines diagnosed?
It is estimated that nearly half of migraine sufferers in the US remain undiagnosed.3 You should see a doctor if you experience more than 2 debilitating headaches a month that are accompanied by any of the following symptoms:
- Flashing lights or other visual disturbances (migraine with aura)
- Sensitivity to light or sound
- Nausea and vomiting
- Fatigue
- Loss of appetite
Migraine diagnosis usually consists of a medical history of migraine-related symptoms as well as a family history of migraines. Typical questions the doctor will ask about your headache include:
- When did your headaches start?
- What do they feel like? Are they worse on one side of the head than the other?
- How long do they last?
- What are your symptoms before, during, and after a headache?
- What medications have you tried to ease the pain?
A physical and neurological examination and imaging tests such as CT scan or MRI may be done to rule out other causes. A CT scan may be used if you have never had migraines before or if they have changed recently, because the test can rule out brain abnormalities such as bleeding. MRI and MRA may be done for a more detailed evaluation. X-rays and other tests can rule other types of headache, such as a sinus headache.
One of the most important tools in the diagnosis and treatment of migraines is the headache diary. A headache diary records the date and time of your headache, where you had the headache, potential triggers, and the intensity of the headache. See Resources for links to headache diary samples.
Half of migraine sufferers are not diagnosed and do not receive treatment for their migraines. You should seek help if you think you may be suffering from migraines. For information on how you can find a headache specialist, see our Resources section.
How are migraines treated?
Migraines cannot be cured, but the symptoms can be controlled and future attacks can be prevented with medication and by avoiding the triggers that cause a migraine. A healthy diet, exercise, and regular sleep hours can also help to reduce the incidence of migraines.
Your doctor may recommend or prescribe medication to treat the pain and other symptoms associated with migraines. Mild migraines can respond to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil, Motrin, and Aleve. Moderate migraines may be treated with a nonprescription combination of aspirin, acetaminophen, and caffeine. If you have migraines that do not respond to nonprescription drugs or that are severe and frequent (more than 2 days a week), your doctor may prescribe medications that reduce or prevent migraines, such as beta-blockers, anticonvulsants, calcium channel blockers, and antidepressants. Other types of drugs can stop an attack once it starts, such as triptans (Imitrex, Axert, Maxalt). Triptans are not recommended for women at high risk for heart disease and blocked-vessel stroke because they can cause blood vessels to narrow.
How can I prevent a stroke if I have migraines?
Frequent migraines with aura for long periods of time increase a woman's risk of stroke. However, it is not clear if taking medication to reduce the number of migraines also reduces the risk of blocked-vessel stroke and heart attack.11 Because of their increased stroke risk, women who have migraines need to manage their other risk factors for stroke and heart disease, including high blood pressure, high cholesterol, birth control pills, and smoking.11
Talk to your doctor about steps you can take to control your blood pressure and cholesterol. If you smoke, you should seriously consider quitting. If birth control pills are making your migraines worse, discuss with your doctor the possibility of switching to a birth control pill with lower amounts of hormones or to another method of birth control.
A healthy diet with regular exercise and sleep will help not only your migraines but your quality of life overall.
