Chronic migraines can mimic several other conditions, such as tension headaches, medication rebound headaches, Meniere’s disease, and trigeminal neuralgia. Like migraines, these conditions are not associated with abnormalities on diagnostic tests. Migraines require a different treatment approach than these other conditions, which makes accurate diagnosis important.
Certainly, if you have any headache warning signs or if there is a concern that you could have a serious neurological illness, such as a transient ischemic attack (TIA) or multiple sclerosis (MS), your healthcare provider will need to rule out these conditions using diagnostic tools such as physical examination and imaging tests.
Migraine Questionnaires
Several questionnaires, also described as screening tests, can help differentiate migraines from similar conditions because they focus on certain migraine characteristics. There is also a screening tool that your healthcare provider may use to identify whether you could be experiencing migraines that you aren’t aware of.
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POUND Mnemonic
An informal way of testing for migraines, the POUND questions can be used to assess the likelihood that your symptoms are caused by migraines.
P: Is your headache throbbing? The “P” refers to the pulsating quality of a migraine. O: How long do your headaches last? The “O” refers to the duration of a person’s headache, which is approximately one day for migraines but can technically be anywhere between four and 72 hours. U: Do your headaches occur on one side of your head? The “U” refers to the unilateral location of a person’s headache. N: Do you experience nausea and/or vomiting with your headaches? The “N” refers to the presence of nausea or vomiting along with the head pain. D: Do you miss work or school because of your headache? The “D” refers to the disabling intensity of a headache.
If four or five of the symptoms are present, there is a 92 percent chance that symptoms are caused by migraines.
If three symptoms are present, the probability decreases to 64 percent.
Finally, if two or fewer of the symptoms are present, the likelihood of migraine is 17 percent.
The ID Migraine Questionnaire
This screening test consists of three “yes” or “no” questions that focus on the duration, disabling effects, and associated symptoms of the episode(s).
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?
An answer of “yes” to two of the three questions suggests a 93 percent chance that migraines are the cause of the symptoms.
Migraine-Screen Questionnaire (MS-Q)
A questionnaire designed to detect migraines among people who do not report the symptoms to their primary healthcare providers, this test consists of five questions:
Do you have frequent or intense headaches?Do your headaches usually last more than four hours?Do you usually suffer from nausea when you have a headache?Does light or noise bother you when you have a headache?Do your headaches limit any of your physical or intellectual activities?
Answering “yes” to four or more MS-Q questions is consistent with possible migraine.
If you have migraines but do not recognize them, you may be prone to taking high doses of pain medications, which can cause side effects and provoke medication rebound headaches.
A Word From Verywell
Keep in mind that your healthcare provider might not use any of these screening questions when evaluating your symptoms. Some healthcare providers are very familiar with migraines and reach that diagnosis without using a formal migraine screening tool, but for many cases, these can be helpful.
