Migraine: diagnostic criteria

The International Headache Society has produced the following diagnostic criteria for migraine without aura:

Point	Criteria
A	At least 5 attacks fulfilling criteria B-D
B	Headache attacks lasting 4-72 hours* (untreated or unsuccessfully treated)
C	Headache has at least two of the following characteristics: 1. unilateral location* 2. pulsating quality (i.e., varying with the heartbeat) 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
D	During headache at least one of the following: 1. nausea and/or vomiting* 2. photophobia and phonophobia
E	Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder)

*In children, attacks may be shorter-lasting, headache is more commonly bilateral, and gastrointestinal disturbance is more prominent.

Migraine with aura (seen in around 25% of migraine patients) tends to be easier to diagnose with a typical aura being progressive in nature and may occur hours prior to the headache. Typical aura include a transient hemianopic disturbance or a spreading scintillating scotoma ('jagged crescent'). Sensory symptoms may also occur

If we compare these guidelines to the NICE criteria the following points are noted:

NICE suggests migraines may be unilateral or bilateral
NICE also give more detail about typical auras:

Auras may occur with or without headache and:

are fully reversible
develop over at least 5 minutes
last 5-60 minutes

The following aura symptoms are atypical and may prompt further investigation/referral;

motor weakness
double vision
visual symptoms affecting only one eye
poor balance
decreased level of consciousness.

+PassMedicine Notes

The International Headache Society has produced the following diagnostic criteria for migraine without aura:

Point _ Criteria| A_At least 5 attacks fulfilling criteria B-D| B _Headache attacks lasting 4-72 hours* (untreated or unsuccessfully treated)| C _Headache has at least two of the following characteristics:

1. unilateral location*
2. pulsating quality (i.e., varying with the heartbeat)
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)|

D _During headache at least one of the following:

1. nausea and/or vomiting*
2. photophobia and phonophobia|

E _Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder)|

*In children, attacks may be shorter-lasting, headache is more commonly bilateral, and gastrointestinal disturbance is more prominent.

Migraine with aura (seen in around 25% of migraine patients) tends to be easier to diagnose with a typical aura being progressive in nature and may occur hours prior to the headache. Typical aura include a transient hemianopic disturbance or a spreading scintillating scotoma ('jagged crescent'). Sensory symptoms may also occur

If we compare these guidelines to the NICE criteria the following points are noted: