Generality
Migraine is a common form of primary headache, characterized by great clinical variability and secondary to multiple triggering factors. The pain is located on one side of the head, typically in the front or side, but it can also be bilateral or spread progressively.
Diagnosis
The first approach to formulate the diagnosis of migraine is based on the analysis of the symptoms reported by the patient . The person is invited to describe the intensity and location of the pain, the frequency of the attacks and any disturbances felt before or during painful crises. The doctor can ask the patient if the headache:
- It presents itself with a throbbing pain of moderate or severe intensity, such as to prevent the performance of normal daily activities;
- It affects one side of the head (unilateral location);
- It is aggravated by physical activity or movement;
- It is accompanied by nausea and / or vomiting and increased sensitivity to light (photophobia) and / or noise (phonophobia).
The information collected allows us to recognize the type of headache, the way it manifests itself and its recurrence (isolated, episodic or chronic). To help the doctor to identify possible triggers, it can be useful to keep a " headache diary ", where to record the details that characterize the migraine attacks: temporal references (date and time), description of the pain (type, location, intensity), duration and frequency), any medications taken, foods consumed, activities carried out before its appearance etc. The compilation of this register can be useful both to monitor the progress of migraine attacks and to determine the effectiveness of any therapeutic approach undertaken.
In addition to the anamnesis, it is essential to complete the evaluation with the physical examination, which allows the doctor to investigate the causes and triggers of migraine.
The visit consists in checking some physical and neurological parameters, such as:
- Blood pressure and heart rate;
- Breathing abnormalities, nausea, vomiting and fever;
- Examination of the cervical muscles and the temporomandibular joint;
- Motor, sensory, cerebral, cognitive and visual acuity functions.
In particular, neurological tests focus on the exclusion of other pathological conditions, which may underlie the onset of migraine. For this purpose, only if there is the suspicion of a secondary type of form, the doctor can subject the patient to some diagnostic investigations, such as computed tomography (CT), brain MRI and electroencephalogram (especially in children). Further diagnostic tests may also include blood tests, cervical spine x-ray, lumbar puncture, echocardiography and complete eye examination.
The patient should urgently undergo a medical check-up if:
- The pain in the head is very intense and occurs suddenly (within one or two minutes);
- Migraine attacks occur more frequently;
- There is a severe headache with fever or other manifestations that usually do not accompany a migraine.
Differential diagnosis . The main conditions that can cause symptoms similar to a migraine attack are:
- Stroke and subarachnoid hemorrhage : they occur with a very rapid onset headache;
- Cluster headache : pain, typically unilateral, occurs periodically, but differs for the shorter duration of the attacks and for the appearance of characteristic symptoms, such as pain around the orbits, nasal congestion and tearing;
- Tension headache : in general, it is bilateral and less disabling than migraine;
- Acute glaucoma: is associated with vision problems;
- Meningitis: manifested by fever;
- Temporal arteritis : it tends to appear in subjects over 50 years of age and, unlike migraine, the value of the ESR (erythrocyte sedimentation rate) is altered;
- Sinusitis : some typical manifestations, such as fever and rhinorrhea, differentiate it from migraine.
