Investigations
1st investigations to order
clinical diagnosis
Test
History and examination are the mainstay of migraine diagnosis.[1]
Result
patient fulfils the International Headache Society's diagnostic criteria for one of the migraine types including 'probable migraine'
Investigations to consider
brain MRI
Test
Not needed in typical cases.
Especially important in atypical cases with atypical course, concerns for increased intracranial pressure, abnormal neurological examination, and positional headache.
Result
normal in migraine; may identify the aetiology of secondary headaches: space-occupying lesions, meningeal enhancement, findings suggestive of increased or decreased intracranial pressure
electroencephalogram
Test
Not needed in typical cases.
To be obtained when late-onset occipital epilepsy is considered a possibility.
Result
normal in migraine; may identify occipital epileptiform discharges in selected cases
lumbar puncture
Test
Not needed in typical cases.
To be considered especially when suspecting central nervous system infection or idiopathic intracranial hypertension or intracranial hypotension.
Result
normal in migraine; may identify abnormal opening pressure, or evidence of infection or inflammation
erythrocyte sedimentation rate (ESR) and CRP
Test
Not needed in typical paediatric migraine cases.
To be considered when vasculitis or other inflammatory conditions are suspected.
Result
normal in migraine
head CT
Test
Not needed in typical paediatric migraine cases.
Necessary when acute intracranial bleeding needs to be ruled out.
Result
normal in migraine
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