Diagnosing migraine: Are the criteria valid or invalid?

Abstract

Making a clinical diagnosis is a thought process but we do not know how we remember, let alone think. Migraine attacks are dynamic, with symptoms evolving, progressing and regressing during 4 – 72 h. Some of us attempt to abstract criteria from this “drama”, others try to see the whole “play” as a stage performance. However, we are dependent on patients’ descriptions and must carefully evaluate the responses to our questions. Describing pain quality–translating feelings into words–is especially difficult. Patients can be led or misled by questions, particularly if posed by insensitive questioners applying rigid criteria. Nevertheless, criteria are essential for the inclusion or exclusion of patients in drug trials or a series when special investigations are being conducted, but not in a difficult diagnostic case when there are two concomitant headaches or when trying to help someone cope with migraine.