Several sets of guidelines have been developed to assist in the diagnosis of
migraine:
TheInternational Headache Society Classification of Headache Disorders
The second edition of the International Classification of Headache Disorders [1] has been described as “perhaps the single-most important document to read for physicians taking an interest in the diagnosis and management of headache patients”. Developed by the International Headache Society, it was designed with the intention of promoting worldwide agreement in the way that headache is classified.
A detailed classification of migraine with and without aura according to the second edition of The International Headache Society Classification of Headache Disorders is provided here.
HCPC guidelines
Although The International Headache Society Classification of Headache Disorders provides comprehensive and precise information on various headache disorders, the detailed nature of the guidelines may make them an impractical clinical tool for primary care physicians. Indeed, most primary care physicians rate their knowledge of the guidelines as especially poor. [50]
The Headache Care for Practising Clinicians (HCPC) guidelines may be a more useful tool to assist in the diagnosis of migraine in primary care. These international guidelines are targeted towards healthcare professionals with an interest in headache, including physicians, nurses, pharmacists and other practitioners.
Twelve principles of migraine management have been identified by HCPC. Of these, two relate to screening and diagnosis. [16]
The HCPC guidelines can be accessed by clicking here.
US Headache Consortium
The guidelines of the US Headache Consortium [51] provide the following recommendations for diagnostic testing in non-acute headache patients(encompassing all headache syndromes that have occurred for at least four weeks during a patient’s lifetime).
The following symptoms significantly increase the odds of finding a significant abnormality on neuroimaging in patients with non-acute headache:
-
The International Headache Society Classification of Headache Disorders
-
HCPC guidelines
- US Headache Consortium
TheInternational Headache Society Classification of Headache Disorders
The second edition of the International Classification of Headache Disorders [1] has been described as “perhaps the single-most important document to read for physicians taking an interest in the diagnosis and management of headache patients”. Developed by the International Headache Society, it was designed with the intention of promoting worldwide agreement in the way that headache is classified.
A detailed classification of migraine with and without aura according to the second edition of The International Headache Society Classification of Headache Disorders is provided here.
HCPC guidelines
Although The International Headache Society Classification of Headache Disorders provides comprehensive and precise information on various headache disorders, the detailed nature of the guidelines may make them an impractical clinical tool for primary care physicians. Indeed, most primary care physicians rate their knowledge of the guidelines as especially poor. [50]
The Headache Care for Practising Clinicians (HCPC) guidelines may be a more useful tool to assist in the diagnosis of migraine in primary care. These international guidelines are targeted towards healthcare professionals with an interest in headache, including physicians, nurses, pharmacists and other practitioners.
Twelve principles of migraine management have been identified by HCPC. Of these, two relate to screening and diagnosis. [16]
-
Almost all headaches are benign/primary and can be managed by all practising clinicians.
- Use questions/a questionnaire to assess the impact of migraine on daily living and everyday activities, for diagnostic screening and to aid management decisions.
The HCPC guidelines can be accessed by clicking here.
US Headache Consortium
The guidelines of the US Headache Consortium [51] provide the following recommendations for diagnostic testing in non-acute headache patients(encompassing all headache syndromes that have occurred for at least four weeks during a patient’s lifetime).
-
Procedures of diagnostic screening and confirmatory differential diagnosis should be conducted.
-
Diagnosis should be based on The International Headache Society Classification of Headache Disorders.
-
Neuroimaging should be considered in patients with non-acute headache and an unexplained abnormal finding on neurological examination
– Neuroimaging is not usually warranted in patients with migraine and a normal neurological examination
– A lower threshold for neuroimaging may be applied for patients with a typical headache features or patients who do not fulfil the strict definition of migraine or other primary headache disorder (or who have some additional risk factor, such as immune deficiency).
The following symptoms significantly increase the odds of finding a significant abnormality on neuroimaging in patients with non-acute headache:
-
Rapidly increasing headache frequency
-
History of dizziness or lack of co-ordination
-
History of subjective numbness or tingling
- History of headache causing awakening from sleep (although this can occur with migraine and cluster headache).
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