Diagnostic criteria

Last edited 8 Nov 2020. Last reviewed 10 Jan 2023

the migrainous attacks are episodic and vary within and among patients
- not all features are present in every attack or in every patient (1).
- in other words migraine is heterogeneous in frequency, duration, and disability (2).
a combination of features is used for the diagnosis.
a diagnosis of migraine headache may be determined if the following criteria, which is based on the criteria outlined by the International Headache Society, are met with (3)

Type of Migraine	Diagnostic Criteria
Migraine without aura	At least five attacks that meet the following four criteria: Headache lasting 4–72 hours (when untreated or unsuccessfully treated) Headache with at least two of the following four characteristics: - Unilateral location - Pulsating quality - Moderate or severe pain intensity - Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs) Headache accompanied by at least one of the following symptoms: - Nausea, vomiting, or both - Photophobia and phonophobia Not better accounted for by another ICHD-3 diagnosis
Migraine with aura	At least two attacks that meet the following three criteria: One or more of the following fully reversible aura symptoms: Visual Sensory Speech, language, or both Motor Brain stem Retinal At least three of the following six characteristics: At least one aura symptom spreading gradually over a period >=5 minutes Two or more aura symptoms occurring in succession Each aura symptom lasting 5–60 minutes At least one unilateral aura symptom At least one positive aura symptom Headache accompanying the aura or following the aura within 60 minutes Not better accounted for by another ICHD-3 diagnosis
Chronic migraine	Headaches (suggestive of migraine or tension headaches) on >=15 days/month for >3 months that fulfill the following criteria: Occurring in a patient who has had at least five attacks meeting the criteria for migraine without aura or the criteria for migraine with aura or both On >=8 days/month for >3 months, features of migraine without aura or of migraine with aura or believed by the patient to be migraine at onset that is relieved by a triptan or ergot derivative Not better accounted for by another ICHD-3 diagnosis

Reference:

1. Goadsby PJ, Lipton RB, Ferrari MD. Migraine — Current Understanding and Treatment.N Engl J Med 2002 ; 346:257
2. Stephen D. Silberstein and Jay Rosenberg. Multispecialty consensus on diagnosis and treatment of headache. Neurology 2000;54:1553
3. Peter J Goadsby. Recent advances in the diagnosis and management of migraine. BMJ 2006;332:25-29
4. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211

Clinical features of childhood migraine

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Diagnostic criteria

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