Migraine Diagnostic Criteria

Migraine Without Aura (Common Migraine)

The International Classification of Headache Disorders (ICHD-3) criteria require at least 5 attacks meeting specific headache characteristics, associated symptoms, and exclusion of other causes for a diagnosis of migraine without aura, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
The headache duration for migraine without aura is typically 4-72 hours when untreated or unsuccessfully treated, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
In children and adolescents, migraine without aura attacks may last 2-72 hours, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 1, 3
Migraine without aura requires at least two of the following headache characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, and aggravation by or causing avoidance of routine physical activity, as specified by the American Academy of Otolaryngology-Head and Neck Surgery and the International Headache Society 1, 2
Associated symptoms for migraine without aura include nausea and/or vomiting, and both photophobia and phonophobia, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery and the International Headache Society 1, 2

The diagnosis of migraine with aura requires at least 2 attacks meeting specific aura symptoms and characteristics, as stated by the American Academy of Otolaryngology-Head and Neck Surgery and the International Headache Society 1, 2
Aura symptoms for migraine with aura include visual, sensory, speech and/or language, motor, brainstem, and retinal symptoms, as specified by the American Academy of Otolaryngology-Head and Neck Surgery and the International Headache Society 1, 2
Aura characteristics for migraine with aura include at least one aura symptom spreading gradually over ≥5 minutes, two or more aura symptoms occurring in succession, and each individual aura symptom lasting 5-60 minutes, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery and the International Headache Society 1, 2

The diagnosis of chronic migraine requires headache on ≥15 days per month for >3 months, prior history of at least 5 attacks meeting criteria for migraine without aura and/or migraine with aura, and on ≥8 days per month for >3 months, the headache meets criteria for migraine without aura OR migraine with aura OR is believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative, as stated by the International Headache Society and the American Academy of Neurology 2, 4

Key historical features to elicit in patients with suspected migraine include age at onset, family history, attack frequency and duration, pain location, quality, and severity, aggravating and relieving factors, accompanying symptoms, and presence and characteristics of aura symptoms, as recommended by the American Academy of Neurology and the International Headache Society 2
A common diagnostic pitfall is failing to recognize that both photophobia AND phonophobia must be present together for migraine without aura, however, nausea/vomiting can substitute for this requirement, as stated by the American Academy of Otolaryngology-Head and Neck Surgery and the International Headache Society 1, 2

The American Academy of Neurology notes that migraine with sensory aura is a subtype of migraine with aura characterized by fully reversible sensory symptoms that spread gradually over at least 5 minutes, usually in the face or arm, and last 5-60 minutes before or during the headache phase 5, 6
Sensory aura occurs in approximately 31% of individuals who experience migraine with aura, making it the second most common aura type after visual aura 7

The International Headache Society recommends that to diagnose migraine with sensory aura, patients must have at least 2 attacks meeting specific criteria, including one or more fully reversible sensory aura symptoms and at least 3 of 6 characteristics, such as gradual spread, successive symptoms, and unilateral symptoms 5, 6
The diagnostic criteria include symptoms that spread gradually over ≥5 minutes, last 5-60 minutes, and are accompanied or followed within 60 minutes by headache 5, 6

The American Heart Association and the American Stroke Association note that the most important distinction is between migraine sensory aura and transient ischemic attack (TIA), as both can present with unilateral sensory symptoms 5, 6
Migraine aura is characterized by symptoms that spread gradually, occur in succession, and have a "marching" quality, whereas TIA symptoms have sudden, simultaneous onset with maximal deficit at onset 5, 6