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Diagnosing Migraine

Migraines are debilitating, recurrent headaches that cause moderate to severe throbbing pain. The pain may be on one or both sides of the head.

Most people experience headache pain every now and then. This pain can typically be relieved using over-the-counter medication. But if your headaches become severe, NYU Langone doctors can provide you with the best and most effective treatment plan.

Migraines can be chronic, meaning they occur 15 or more days per month over a 3-month time span. Or, they may be episodic, meaning they occur fewer than 15 days per month.

Migraine pain may intensify with movement or physical activity. Untreated, a migraine attack duration can range from four hours to days.

People who experience migraines tend to have recurring attacks that can be triggered by a variety of factors, such as anxiety, stress, hormonal changes, bright or flashing lights, and certain foods or drinks.

Visual or sensory symptoms often accompany migraines, causing sensitivity to light and sound as well as nausea or vomiting. People may also experience trouble speaking, dizziness, numbness, confusion, or other stroke-like symptoms during a migraine.

Types of Migraine

There are two primary types of migraine. Both cause pain, although the type and severity of this pain varies.

Migraine with Aura

An aura is a physiological warning sign that a migraine is about to start. Visual aura is the most common type of aura. Visual auras include bright flashing dots or lights, blind spots or distorted vision, temporary vision loss, and wavy or jagged lines.

Auras can affect the other senses as well. People having a migraine with aura may experience a ringing in the ears, which is known as tinnitus, or changes in their sense of smell, taste, or touch. They may also describe having a "funny feeling."

An aura can occur before or at the beginning of the head pain, and it can last from 15 minutes to 1 hour.

Migraine Without Aura

Migraine without aura does not include visual or sensory symptoms. If left untreated, this type of migraine can last from 4 to 72 hours. It involves pulsating pain of moderate-to-severe intensity on one or both sides of the head.

These headaches are accompanied by at least one of the following: hypersensitivity to or avoidance of light, hypersensitivity to or avoidance of sound, and nausea, vomiting, or both.

Migraine without aura is the most common type of migraine. These types of headaches occur more frequently and are usually more disabling than migraine with aura.

Diagnostic Tests for Migraine

Relying on over-the-counter pain medication to treat chronic migraines can lead to overuse of these medications, which, over time, can make migraines worse and unresponsive to treatment, even when the medications are used as directed. Doctors at NYU Langone can help to ensure you are not experiencing headaches or migraines as a result of medication overuse.

To determine if migraines are causing your pain, neurologists at NYU Langone ask about your symptoms, focusing on the frequency, intensity, duration, location, and any known triggers. Your doctor also asks about your medical history and performs a physical exam to obtain a complete picture of your health.

A careful review of your symptoms can help your doctor to determine the type of migraine you’re experiencing and if an underlying condition could be the cause.

Your doctor may use one or more of the following tests to arrive at the most accurate diagnosis.

Neurological Exam

A neurological examination may include an evaluation of your mental status, motor strength, vision, and reflex testing. Your doctor may also assess the function of the nerves connected to the brainstem—the cranial nerves. He or she does this by testing for sensation in the face, checking your hearing and eye movements, asking you to swallow or say “ahh,” and observing your ability to move your head, neck, and shoulders.

The doctor may test your vision and look for any signs of increased pressure in your head. Your reflexes may also be checked.

The neurological examination is done to help determine whether the migraines originate from a brain tumor or blood clot in the brain, or to rule out the possibility that another condition may be causing your symptoms.

MRI Scans

In MRI scans, magnetic waves and computers are used to create two- or three-dimensional images of the inside of the head and neck. A doctor may order an MRI scan to look for other conditions that can cause headaches, such as a tumor or abscess, which is a collection of pus that has formed in response to an infection.

Sometimes MRI scans of the neck are used to identify any problems with the bones in the neck—also referred to as the cervical spine—that may be triggering the migraines.

Magnetic Resonance Angiogram

Similar to an MRI, a magnetic resonance angiogram (MRA) is an imaging technique used to check for an abnormality, such as an aneurysm, in the blood vessels of the brain.

The test may involve injecting dye into a blood vessel, so that your doctor can view blood flow in the arteries or veins of the head or neck. Some MRA scans can be done without the use of dye.

MRA scans allow your doctor to see if blood vessels are blocked by a clot or if there are any other factors that may be restricting or increasing blood flow and triggering headaches.

Our Research and Education in Migraine

Learn more about our research and professional education opportunities.