Migraine Characteristics

What is a migraine? The definition of a migraine headache excludes headaches that are secondary to something else going on like a brain tumor, infection, etc.

This can only be done with a neurological examination but there are some historical features that set off “alarms” in doctors mind during a history – fever with your headache (go to ER), worst headache in your life that starts suddenly or escalates in only a minute or two (quit reading and go to the ER). Other “alarms” that make doctors look for a secondary cause include migraines starting over the age of 50, history of cancer, history of immunodeficiency, sudden change in headache pattern, and a headache that starts one day and never stops. The longer you have had headaches that come and go for days at a time, the more likely you have a primary headache type. We then look at your symptoms during your most severe headaches and see if they appear to meet the definition of migraine which is reproduced below and can be found online at the official International Classification of Headache Disease website.

Some common characteristics of migraine are not part of definition.  This includes allodynia (non-painful stimuli are painful), vertigo, difficulty thinking (cognitive complaints, brain fog), and fatigue. These additional migraine symptoms can be more disabling than migraine pain in some patients.

Patients over the age of 16 must fulfill the following criteria to be diagnosed with Common Migraine:

A. At least 5 attacks fulfilling B, C and D
B. Untreated or unsuccessfully treated headache attacks lasting 4-72 hours
C. Headaches that have at least two of the following characteristics:

• Unilateral (one-sided) location
• Pulsating or throbbing quality (like a heart beat)
• Moderate or severe intensity (moderate is generally defined as inhibiting daily activities and severe is defined as prohibiting daily activities.)
• Aggravation by physical activity such as walking stairs or similar routine

D. During the headache at least one of the following occurs:

• Nausea and/or vomiting
• Photophobia (lights seem unusually bright) and phonophobia (sounds seem unusually loud)

E. No other diagnosis to explain the headache.

The purpose of the migraine headache criteria is to make sure someone with a different disease is not improperly diagnosed with migraine.

This is why 5 headaches are required to make the diagnosis of migraine headache.  These rules also make patients in clinical trials more uniform.

Some patients have an aura prior to their headache. An aura is defined by the official criteria as recurrent attacks, lasting minutes, of unilateral fully-reversible visual, sensory or other central nervous symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms. Types of aura and the characteristics of an aura are found online. Because these are so characteristic of migraine headaches, only 2 auras in your life followed by a typical migraine type headache is enough to diagnosis you with migraine with aura.

If you met criteria C above but not D, or if you meet D and only one item from C, then you could have probable migraine. As its name implies, given the years that we have worked with our current definitions, probable migraine is indeed probably migraine and for treatment purposes, nothing else changes.