Migraine Headaches

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Diagnosis

Diagnosis of migraine is based on the history of symptoms, physical examination, and neurological tests. The tests are performed to rule out other neurological and cerebrovascular conditions, including the following:

• Bleeding within the skull (intracranial hemorrhage)
• Blood clot within the membrane that covers the brain (cerebral venous sinus thrombosis)
• Cerebral stroke (infarct)
• Dilated blood vessel in the brain (cerebral aneurysm)
• Excess cerebrospinal fluid in the brain (hydrocephalus)
• Inflammation of the membranes of the brain or spinal cord (meningitis)
• Low level of cerebral spinal fluid (CSF)
• Nasal sinus blockage
• Postictal headache, which occurs after a stroke or seizure
• Tumor

Laboratory Tests

Computed tomography (CT scan) is performed to rule out an underlying brain abnormality when migraines are new or when there is a change in their character or frequency. CT scan involves injecting contrast dye and then taking a series of x-rays.

Electroencephalography (EEG) records electrical signal within the brain using electrodes placed on the scalp. This test is used to detect malfunctions in brain activity (e.g., seizures).

Spinal tap (lumbar puncture) is performed to detect infection and determine levels of white blood cells, glucose, and protein in the cerebrospinal fluid. This test involves withdrawing a small amount of fluid and examining it under a microscope.

Magnetic resonance imaging (MRI scan) and magnetic resonance angiography (MRA) may be performed for a more complete evaluation. MRI produces clear images of the brain using electromagnetic energy. MRA produces images of blood vessels in the brain and is used to detect aneurysms and other vascular abnormalities.

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