Diagnosing Migraine in Primary Care

Your friend, your aunt, your patient in your primary care office, medication commercials with celebrities - everyone seems to be talking about migraine. But is it a headache or is it a migraine? How do you know the difference?

As a new grad, it’s not unusual to feel like you have been thrown into the deep end when patients present with a migraine or a headache. It’s not a super black and white topic; there are not a lot of objective findings or tests that you can order to get evidence. On top of that, patients sometimes have a hard time describing their symptoms, adding to the challenge.

Diagnosing Migraine in Primary Care

This week, we’ll talk about what makes a migraine different from a headache, and how to approach your patient who just knows that their head hurts and they want relief.

✅ Differentiating headaches and migraines

✅ Migraine red flags

✅ Other diagnoses that can be mistaken for migraine

✅ A word about auras

✅ The importance of a headache diary for you and your patient

When you have a good handle on the red flags, and what makes a migraine different from a regular headache, managing migraines will get easier for both you and your patient. Check out the links below to learn more about triggers, criteria for auras, and a handy headache diary for your patient (and you). 

(FYI: to slow down the audio speed, hit the gear symbol in the bottom right corner and change it to .75x or .5x. Closed captions are also located at the bottom R  corner of the video.)

Aura criteria:

• At least three of the following six characteristics:
• At least one aura symptom spreads gradually over ≥5 minutes
• Two or more symptoms occur in succession
• Each individual aura symptom lasts 5 to 60 minutes
• At least one aura symptom is unilateral
• At least one aura symptom is positive
• The aura is accompanied, or followed within 60 minutes, by headache 

Further Resources:

• Link to food triggers: https://my.clevelandclinic.org/health/articles/9648-headaches-and-food 

•  Link to headache diary: https://headaches.org/wp-content/uploads/2021/05/HEADACHE-DIARY.pdf 

•  Link to migraine triggers: https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201