Diagnostic Criteria for Headache Disorders

Migraine Diagnosis

The International Headache Society recommends that migraine without aura requires at least five attacks fulfilling specific criteria, including headache attacks lasting 4-72 hours, headache with at least two characteristics such as unilateral location, pulsating quality, moderate or severe pain intensity, and aggravation by routine physical activity, and at least one of the following during headache: nausea and/or vomiting, photophobia and phonophobia 1, 3
The American Academy of Neurology suggests that migraine with aura requires at least two attacks fulfilling specific criteria, including one or more fully reversible aura symptoms, such as visual, sensory, speech and/or language, motor, brainstem, or retinal symptoms, and at least three of six characteristics, including aura symptom duration and headache accompanying the aura 1, 3, 7

The International Headache Society recommends that chronic migraine requires headache on ≥15 days/month for >3 months, occurring in an individual who has had at least five attacks fulfilling criteria for migraine without aura and/or migraine with aura, and on ≥8 days/month for >3 months, headache meets criteria for migraine without aura, migraine with aura, or is believed by the patient to be migraine at onset and relieved by triptan/ergot derivative 1, 3, 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests that vestibular migraine requires at least 5 episodes with vestibular symptoms of moderate/severe intensity lasting 5 min to 72 hours, current or previous history of migraine with/without aura, and one or more migraine features with at least 50% of vestibular episodes, including headache with at least two migraine characteristics, photophobia and phonophobia, or visual aura 7, 5

The International Headache Society recommends the use of headache diaries to record pattern and frequency of headaches, accompanying symptoms, and medication use, and screening questionnaires such as ID-Migraine and Migraine Screen Questionnaire (MS-Q) to aid in diagnosis 8, 4, 9

The American Academy of Neurology suggests that medical history is the mainstay of migraine diagnosis, and physical examination is usually confirmatory, and that ICHD-3 criteria prioritize specificity over sensitivity, with "probable migraine" diagnosis used when all criteria aren't met 1, 8, 9
The International Headache Society recommends considering family history, which strengthens suspicion of migraine, especially with onset around puberty, and being aware that chronic migraine is not static, with patients potentially reverting to episodic migraine or vice versa 1, 3