How to identify if someone suffers from migraine? and how is the migraine categorised ie whether it is severe, mild etc?
How to identify migraine
Traditionally, if you had headaches you would discuss your symptoms with a doctor who would then classify the type of headache you had based on what you reported. If you didn't think of something to report, or didn't think (for example) that your nausea was related to your headaches (and so didn't report it), then your headache type may be misdiagnosed. Personally, I received several different "headache diagnoses" over the years, depending on how I reported my symptoms and the doctor I was seeing at the time.
In 2003, a group of researchers published a study (Lipton) where they determined the ID Migraine test was a reliable screening test for determining whether a patient had migraine. This test was further validated by additional studies in 2011 (Cousins), and has since been translated into additional languages and studied further (Karli).
ID Migraine Test
The ID Migraine test is considered positive for migraine if the patient answers yes to 2 or more of the following 3 questions:
- Has a headache limited your activities for a day or more in the last three months?
- Are you nauseated or sick to your stomach when you have a headache?
- Does light bother you when you have a headache?
More generally, the symptoms of migraine may include:
- Pain on one side or both sides of your head
- Pain that has a pulsating, throbbing quality
- Sensitivity to light, sounds and sometimes smells
- Nausea and vomiting
- Blurred vision
- Lightheadedness, sometimes followed by fainting
- Visual phenomena, such as seeing various shapes, bright spots or flashes of light
- Vision loss
- Pins and needles sensations in an arm or leg
- Speech or language problems (aphasia)
How to classify severity of migraine
Severity of migraine is usually judged based on how the symptoms affect the patient's ability to conduct daily activities. There are several scales available to test this, but the two most popular seem to be the Migraine Disability Assessment (MIDAS) and the Headache Impact Test (HIT).
MIDAS was developed in 2001 (Steward) and is based on asking the patient to count the number of days they have been impacted by their headaches (specifically addressing work, household, and social activities). The more days a person is impacted, the more severe their migraine is considered. MIDAS can be found online at the American Headache Society.
HIT is a newer test, developed in 2011 (Yang). It asks the patient to consider the impact of migraine on their activities in the past 4 weeks, on a five point scale that progresses from "Never" to "Always". Having more responses on the positive end of the scale (Sometimes/Very Often/Always) will indicate that a person is more severely affected by migraine. The HIT can be found online on the National Headaches Foundation.
Cousins G1, Hijazze S, Van de Laar FA, Fahey T. Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis. Headache. 2011 Jul-Aug;51(7):1140-8. doi: 10.1111/j.1526-4610.2011.01916.x. Epub 2011 Jun 7.
Karli, N, Mustafa Ertas, Betül Baykan, Ozlem Uzunkaya, Sabahattin Saip, Mehmet Zarifoglu, Aksel Siva, and MIRA study group. The validation of ID migraine™ screener in neurology outpatient clinics in Turkey. J Headache Pain. 2007 Sep; 8(4): 217–223. Published online 2007 Sep 24. doi: 10.1007/s10194-007-0397-4
Lipton RB, Dodick D, Sadovsky R, Kolodner K, Endicott J, Hettiarachchi J, Harrison W; A self-administered screener for migraine in primary care: The ID Migraine validation study. Neurology. 2003 Aug 12;61(3):375-82.
Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6 Suppl 1):S20-8.
Yang M, Rendas-Baum R, Varon SF, Kosinski M. Validation of the Headache Impact Test (HIT-6TM) across episodic and chronic migraine. Cephalalgia. 2011;31(3):357-367. doi:10.1177/0333102410379890.
A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks Terrin A, Mainardi F, Lisotto C, Mampreso E, Fuccaro M, Maggioni F, Zanchin G. A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacksCephalalgia. 2019 https://doi.org/10.1177/0333102419877661
The migraine is a chronic neurological disease. Its main symptom is usually an intense headache that occurs at the front or on one side of the head and the pain could gets worse when you move and prevents you from carrying out normal activities.
The symptoms of a migraine can usually last for few hours or few days. Other common symptoms could include: nausea, vomiting and increased sensitivity to light and sound, however not everyone experiences these additional symptoms. Some other could include sweating, poor concentration, feeling very hot or very cold, abdominal (tummy) pain and diarrhoea. Migraine headaches are often undiagnosed and untreated.
There are several types of migraine how it's categorised, such asNHS:
migraine with aura,
This is when there are warning sings before migraine starts (such as flashing lights).
migraine without aura,
Where migraine occurs without warning sings.
migraine aura without headache.
Where other symptoms are experienced (such as aura), but without headache.
And the main stages of a migraine (although not everyone goes through all of these) areNHS:
'Prodromal' (pre-headache) stage
This early symptom can indicate the start of a disease. For example changes in mood, energy levels, behaviour and appetite can occur several hours or days before an attack.
Retinal migraine (visual migraine) can be accompanied by visual disturbances such as flashes of light or blind spots, which can last for five minutes to an hour or even temporary blindness in one eye.
It vary by individual experience (smells, lights, or hallucinations).
Throbbing or pulsatile pain on one side or both sides of the head lasting for few hours to 72 hours. Often accompanied by nausea, vomiting, and/or extreme sensitivity to bright light and loud sounds.
Postdrome (Resolution stage)
When symptoms gradually fade away, you may till feel tired for a few days afterwards. During this time you may feel drained and washed out, some other people report feeling mildly euphoric.
- What are the general causes of migraine and how can it be treated?
- Tension headache at Wikipedia
- Migraine Symptoms by Mayo Clinic Staff