If you or someone you love has been struggling with recurring headaches and other unexplained symptoms, migraine may be a possible explanation.

Migraine is a neurological condition that can severely impact your ability to participate in normal daily activities. But despite its prevalence, it often takes multiple appointments to get the right diagnosis.

In this guide, we cover what you need to know about the migraine diagnosis process, including the diagnostic criteria, what to expect at your doctor’s appointments, and how to prepare for them.

Let’s get into it.

What is a migraine?

It’s common for people to assume migraine is just a bad headache, but that is far from the truth.

Migraine is a neurological condition that causes a wide range of symptoms, including pulsating pain on one side of the head, nausea, and light sensitivity.

It’s one of the most common neurological conditions globally, affecting an estimated 1.1 billion people. Despite its prevalence, 50–80% of people with migraine receive the wrong diagnosis.

This is partly because migraine does not look the same in everyone, and there are many different types.

For instance, some people experience aura symptoms, while others do not. Even among people with aura, symptoms can vary considerably, ranging from visual disturbances to sensory or speech difficulties. Migraine symptoms can change over time and often overlap with other conditions.

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When to see a doctor about migraine

Having a headache every once in a while is not usually a cause for concern. However, recurring headaches or migraine-like symptoms are worth discussing with a doctor, especially if they are affecting your daily life.

It’s generally advised to see a doctor if:

• You have recurring headaches that impact your ability to participate in your typical routine.
• You also experience neurological symptoms (visual, motor, sensory, or speech changes) with your headache.
• Your headache symptoms have changed over time.
• Your headaches are not improving with over-the-counter medications, rest, hydration, or other measures you would normally use to manage symptoms.

If you meet any of the criteria above, speak to your doctor. They can help determine whether migraine may be causing your symptoms, rule out other possible causes, and discuss treatment options if needed.

Diagnostic criteria for migraine

No single test can diagnose migraine. Instead, diagnosis is based on clinical assessments carried out by a doctor or specialist.

During an initial appointment, your doctor will probably ask you questions to determine if you meet the diagnostic criteria for migraine. The exact criteria depend on the type of migraine being considered.

They will clarify whether you have had at least five attacks that fulfill the following four criteria:

1. Headaches lasting 4–72 hours
2. Those headaches have two of the following characteristics:
   
   • Are one-sided
   • Have a pulsating quality
   • Are moderate to severe in pain intensity
   • Are made worse by your normal daily activities or cause you to avoid them
3. During a headache, you also experience at least one of the following additional symptoms:
   
   • Nausea and/or vomiting
   • Light and/or sound sensitivity

Migraine diagnosis is often more complex than these criteria suggest. For subtypes of migraine, including migraine with aura, chronic migraine, hormonal migraine, silent migraine, and more, your doctor will be looking to see whether your experiences fit with additional diagnostic criteria.

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Your migraine appointment: What to expect and how to prepare

Booking an appointment with your primary care provider is the first step to getting answers. 

These early appointments can be overwhelming and frustrating, especially if you have been struggling with untreated migraine symptoms for a while. Coming to these appointments prepared is the best way to advocate for your needs and ensure your doctor sees the full picture.

Questions your doctor may ask

Expect your doctor to ask you a series of questions during your appointment. Here are some examples you can prepare answers for:

• Are you the only member of your family who gets headaches? If not, who does?
• What do your episodes feel like?
• When did these episodes start?
• Where in your head does your head pain impact? Is it one-sided, or does it spread or move to both sides?
• How long do your episodes usually last?
• How many episodes do you have in a week? How many in a month?
• On a scale from 1–10, how severe would you say your symptoms are during an episode?
• Are your symptoms intense right away, or do they gradually worsen during an episode?
• Besides head pain, what other symptoms do you experience before, during, or after an episode?
• Do you experience aura symptoms (visual disturbances, numbness, tingling, or difficulty speaking, etc.) during your episodes?
• Are there specific times of day when you are more likely to experience an episode?
• Have you noticed any specific triggers?
• Do your episodes impact your ability to participate in your typical daily activities?
• Have you tried taking any medications to ease your symptoms? If so, did they work?
• Have you made any lifestyle changes to help manage your symptoms? If so, did they work?

Your doctor will use your answers to determine the next course of action. Depending on your symptoms and health history, you may be referred to a specialist or undergo diagnostic imaging to rule out other possible causes.

Diagnostic tests to rule out other conditions

While diagnostic imaging can’t diagnose migraine, it can rule out other conditions that may be causing your symptoms.

The two most common types of diagnostic imaging scans include:

• Magnetic resonance imaging scan (MRI): This scan uses magnetic fields and radio waves to create images of your brain, including the brain structures and blood vessels. MRIs can rule out tumors, strokes, brain bleeds, and infections in the brain.

• Computerized tomography scan (CT scan): This scan uses multiple X-ray images to create detailed cross-sectional images of the structures of the brain. They can also help rule out things like tumors, infections, brain injuries, and brain bleeds that may be causing your symptoms.

What to bring with you to your migraine appointment

To make the appointment as productive as possible, we recommend bringing the following things to share with your doctor:

• Your ID and insurance card
• A complete list of your current medications
• A list of supplements you take
• Medical history documents
• The names of doctors you’ve seen in the past
• A symptom journal that covers at least 14 days

When migraine specialists get involved

There are many reasons why you may be referred to see a migraine specialist. The most common specialists involved in diagnosing migraine are neurologists or headache specialists.

You might be referred in the following situations:

• You have a high frequency of migraine episodes
• You frequently use medications to manage symptoms
• You have more severe migraine symptoms that affect your speech or movement
• Your migraine episodes severely impact your ability to work or participate in daily activities

Tracking your symptoms can speed up the diagnostic process

Despite how common migraine is, getting diagnosed is not always straightforward. It often involves multiple appointments with doctors and specialists.

Keeping a daily record of your symptoms is essential for helping that process along and ensuring that none of your symptoms are missed or brushed over. Doctors need detailed information, and it’s tricky to reliably recall months of symptoms from memory.

Using the Human Health app, you can keep a detailed record of your experiences, including how often attacks happen, how long they last, the symptoms you have, and what medications or lifestyle changes help.

After collecting this data over a few months, the app can identify patterns and insights you can share with your doctor, making the diagnostic process less complicated and time-consuming.

Frequently asked questions

What happens during a migraine assessment?

During your first migraine assessment appointment, you can expect your doctor to ask you a series of questions about your attacks and past medical history. The questions will likely be about your symptoms, possible triggers, family history, frequency, and episode duration.

To ensure you provide the most accurate answers, it is helpful to bring a detailed symptom journal to this appointment. 

Do I need a brain scan to diagnose migraine?

No, it’s not possible to diagnose migraine through a CT or MRI brain scan.

If your doctor has ordered brain diagnostic imaging, it is likely to rule out other conditions that could be causing your symptoms.

Can my primary care doctor diagnose migraine?

Yes, a general physician can diagnose migraine by reviewing your symptoms, conducting physical and neurological assessments, and reviewing your medical history. This is usually the first step of the diagnostic process. 

In more complex cases, your primary care doctor might refer you to specialists like neurologists or headache specialists for additional assessments.

Disclaimer: Human Health is a health tracking platform and does not provide medical advice, diagnosis, or treatment. The information in this guide is for educational purposes only and is not a substitute for professional medical care. Always consult your doctor or healthcare provider with questions about your health.

Sources:

1. Migraine, The National Institute of Neurological Disorders and Stroke
2. Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities (2022)
3. Healthcare resource use and costs associated with the misdiagnosis of migraine (2024)
4. Migraine without aura, The International Classification of Headache Disorders
5. What to expect from the first-time visit to a headache specialist? The American Migraine Foundation
6. Migraine, Mayo Clinic