diagnostic criteria

Last edited 11/2020 and last reviewed 10/2022

  • the migrainous attacks are episodic and vary within and among patients
    • not all features are present in every attack or in every patient (1).
    • in other words migraine is heterogeneous in frequency, duration, and disability (2).
  • a combination of features is used for the diagnosis.
  • a diagnosis of migraine headache may be determined if the following criteria, which is based on the criteria outlined by the International Headache Society, are met with (3)
    • Diagnostic Criteria for Migraine without Aura, Migraine with Aura, and Chronic Migraine - Diagnostic criteria are from the International Classification of Headache Disorders, 3rd edition (ICHD-3) (4)

      Type of Migraine Diagnostic Criteria
      Migraine without aura

      At least five attacks that meet the following four criteria:
      Headache lasting 4–72 hours (when untreated or unsuccessfully treated)

      Headache with at least two of the following four characteristics:

      - Unilateral location
      - Pulsating quality
      - Moderate or severe pain intensity
      - Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)

      Headache accompanied by at least one of the following symptoms:
      - Nausea, vomiting, or both
      - Photophobia and phonophobia

      Not better accounted for by another ICHD-3 diagnosis

      Migraine with aura

      At least two attacks that meet the following three criteria:
      One or more of the following fully reversible aura symptoms:

      Speech, language, or both
      Brain stem

      At least three of the following six characteristics:
      • At least one aura symptom spreading gradually over a period >=5 minutes
      • Two or more aura symptoms occurring in succession
      • Each aura symptom lasting 5–60 minutes
      • At least one unilateral aura symptom
      • At least one positive aura symptom
      • Headache accompanying the aura or following the aura within 60 minutes

      Not better accounted for by another ICHD-3 diagnosis

      Chronic migraine

      Headaches (suggestive of migraine or tension headaches) on >=15 days/month for >3 months that fulfill the following criteria:

      Occurring in a patient who has had at least five attacks meeting the criteria for migraine without aura or the criteria for migraine with aura or both

      On >=8 days/month for >3 months, features of migraine without aura or of migraine with aura or believed by the patient to be migraine at onset that is relieved by a triptan or ergot derivative

      Not better accounted for by another ICHD-3 diagnosis