Editing Migraine (section)

==Diagnosis==
The diagnosis of a migraine is based on signs and symptoms.<ref name=Bart10/> [[Neuroimaging]] tests are not necessary to diagnose migraine, but may be used to find other causes of headaches in those whose examination and history do not confirm a migraine diagnosis.<ref name="AHSfive">
* {{cite journal | vauthors = Lewis DW, Dorbad D | title = The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations | journal = Headache | volume = 40 | issue = 8 | pages = 629–32 | date = September 2000 | pmid = 10971658 | doi = 10.1046/j.1526-4610.2000.040008629.x | s2cid = 14443890 }}
* {{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free | title-link = doi }}
* {{cite journal | author = Medical Advisory Secretariat | title = Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis | journal = Ontario Health Technology Assessment Series | volume = 10 | issue = 26 | pages = 1–57 | year = 2010 | pmid = 23074404 | pmc = 3377587 }}</ref> It is believed that a substantial number of people with the condition remain undiagnosed.<ref name=Bart10/>

The diagnosis of migraine without aura, according to the [[International Headache Society]], can be made according the "5, 4, 3, 2, 1 criteria", which is as follows:<ref name=ICHD2004/>
* Five or more attacks&nbsp;– for migraine ''with'' aura, two attacks are sufficient for diagnosis.
* Four hours to three days in duration
* Two or more of the following:
** Unilateral (affecting one side of the head)
** Pulsating
** Moderate or severe pain intensity
** Worsened by or causing avoidance of routine physical activity
* One or more of the following:
** Nausea and/or vomiting
** Sensitivity to both light ([[photophobia]]) and sound ([[Hyperacusis|phonophobia]])

If someone experiences two of the following: photophobia, nausea, or inability to work or study for a day, the diagnosis is more likely.<ref>{{cite journal | vauthors = Cousins G, Hijazze S, Van de Laar FA, Fahey T | title = Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis | journal = Headache | volume = 51 | issue = 7 | pages = 1140–8 | date = Jul–Aug 2011 | pmid = 21649653 | doi = 10.1111/j.1526-4610.2011.01916.x | s2cid = 205684294 }}</ref> In those with four out of five of the following: pulsating headache, duration of 4–72 hours, pain on one side of the head, nausea, or symptoms that interfere with the person's life, the probability that this is a migraine attack is 92%.<ref name=Gilmore2011/> In those with fewer than three of these symptoms, the probability is 17%.<ref name=Gilmore2011/>

===Classification===
{{Main|ICHD classification and diagnosis of migraine}}
<!-- Refractory migraine management missing (maybe include https://doi.org/10.1016/j.ebiom.2023.104943) -->
Migraine was first comprehensively classified in 1988.<ref name="Olesen_2006">{{cite book| vauthors = Olesen J, Goadsby PJ | chapter = The Migraines: Introduction | veditors = Olesen J |title=The Headaches|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|pages=232–233| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA232|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170313073938/https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238|archive-date=13 March 2017}}</ref>

The [[International Headache Society]] updated their classification of headaches in 2004.<ref name=ICHD2004/> A third version was published in 2018.<ref>{{cite journal | vauthors = | title = Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition | journal = Cephalalgia | volume = 38 | issue = 1 | pages = 1–211 | date = January 2018 | pmid = 29368949 | doi = 10.1177/0333102417738202 | doi-access = free | title-link = doi }}</ref> According to this classification, migraine is a primary headache disorder along with [[tension-type headache]]s and [[cluster headache]]s, among others.<ref>{{cite journal | vauthors = Nappi G | title = Introduction to the new International Classification of Headache Disorders | journal = The Journal of Headache and Pain | volume = 6 | issue = 4 | pages = 203–4 | date = September 2005 | pmid = 16362664 | pmc = 3452009 | doi = 10.1007/s10194-005-0185-y }}</ref>

Migraine is divided into six subclasses (some of which include further subdivisions):<ref>{{Cite journal |date=January 2018 |title=Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition |url=http://journals.sagepub.com/doi/10.1177/0333102417738202 |journal=Cephalalgia |volume=38 |issue=1 |pages=1–211 |doi=10.1177/0333102417738202 |pmid=29368949 |issn=0333-1024}}</ref>
* ''Migraine without aura'', or "common migraine", involves migraine headaches that are not accompanied by aura.
* ''Migraine with aura'', or "classic migraine", usually involves migraine headaches accompanied by aura. Less commonly, aura can occur without a headache, or with a nonmigraine headache. Two other varieties are [[familial hemiplegic migraine]] and [[sporadic hemiplegic migraine]], in which a person has migraine with aura and with accompanying motor weakness. If a close relative has had the same condition, it is called "familial", otherwise it is called "sporadic". Another variety is basilar-type migraine, where a headache and aura are accompanied by [[dysarthria|difficulty speaking]], [[Vertigo (medical)|world spinning]], [[tinnitus|ringing in ears]], or a number of other brainstem-related symptoms, but not motor weakness. This type was initially believed to be due to spasms of the [[basilar artery]], the artery that supplies the brainstem. Now that this mechanism is not believed to be primary, the symptomatic term [[ICHD classification and diagnosis of migraine#Migraine with brainstem aura|migraine with brainstem aura (MBA)]] is preferred.<ref name=Basil2009/> [[Retinal migraine]] (which is distinct from visual or optical migraine) involves migraine headaches accompanied by visual disturbances or even temporary blindness in one eye.
* Childhood periodic syndromes that are commonly precursors of migraine include [[cyclical vomiting syndrome|cyclical vomiting]] (occasional intense periods of vomiting), [[abdominal migraine]] (abdominal pain, usually accompanied by nausea), and [[benign paroxysmal vertigo of childhood]] (occasional attacks of vertigo).
* ''Complications of migraine'' describe migraine headaches and/or auras that are unusually long or unusually frequent, or associated with a seizure or brain lesion.
* ''Probable migraine'' describes conditions that have some characteristics of migraine, but where there is not enough evidence to diagnose it as migraine with certainty (in the presence of concurrent medication overuse).
* ''Chronic migraine'' is a complication of migraine, and is a headache that fulfills diagnostic criteria for ''migraine headache'' and occurs for a greater time interval. Specifically, greater or equal to 15 days/month for longer than 3 months.<ref>{{cite journal | vauthors = Negro A, Rocchietti-March M, Fiorillo M, Martelletti P | title = Chronic migraine: current concepts and ongoing treatments | journal = European Review for Medical and Pharmacological Sciences | volume = 15 | issue = 12 | pages = 1401–20 | date = December 2011 | pmid = 22288302 }}</ref>

===Abdominal migraine===
The diagnosis of [[abdominal migraine]] is controversial.<ref name=Abdo2002>{{cite book| vauthors = Davidoff RA |title=Migraine : manifestations, pathogenesis, and management|year=2002|publisher=Oxford Univ. Press|location=Oxford [u.a.]|isbn=9780195137057|page=81|url=https://books.google.com/books?id=PAdn6xC3KlAC&pg=PA81|edition=2|url-status=live|archive-url=https://web.archive.org/web/20161222063436/https://books.google.com/books?id=PAdn6xC3KlAC&pg=PA81|archive-date=22 December 2016}}</ref> Some evidence indicates that recurrent episodes of abdominal pain in the absence of a headache may be a type of migraine<ref name=Abdo2002/><ref>{{cite journal | vauthors = Russell G, Abu-Arafeh I, Symon DN | title = Abdominal migraine: evidence for existence and treatment options | journal = Paediatric Drugs | volume = 4 | issue = 1 | pages = 1–8 | year = 2002 | pmid = 11817981 | doi = 10.2165/00128072-200204010-00001 | s2cid = 12289726 }}</ref> or are at least a precursor to migraine attacks.<ref name = "Olesen_2006" /> These episodes of pain may or may not follow a migraine-like prodrome and typically last minutes to hours.<ref name=Abdo2002/> They often occur in those with either a personal or family history of typical migraine.<ref name=Abdo2002/> Other syndromes that are believed to be precursors include [[cyclical vomiting syndrome]] and [[benign paroxysmal vertigo of childhood]].<ref name = "Olesen_2006" />

===Differential diagnosis===
Other conditions that can cause similar symptoms to a migraine headache include [[temporal arteritis]], [[cluster headache]]s, [[acute glaucoma]], [[meningitis]] and [[subarachnoid hemorrhage]].<ref name=Gilmore2011/> Temporal arteritis typically occurs in people over 50 years old and presents with tenderness over the [[Temple (anatomy)|temple]], cluster headache presents with one-sided nose stuffiness, tears and severe pain around the [[Orbit (anatomy)|orbits]], acute glaucoma is associated with vision problems, meningitis with [[fever]]s, and subarachnoid hemorrhage with a very fast onset.<ref name=Gilmore2011/> [[Tension headaches]] typically occur on both sides, are not pounding, and are less disabling.<ref name=Gilmore2011/>

Those with stable headaches that meet criteria for migraine should not receive [[neuroimaging]] to look for other intracranial disease.<ref>{{cite journal | vauthors = Lewis DW, Dorbad D | title = The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations | journal = Headache | volume = 40 | issue = 8 | pages = 629–32 | date = September 2000 | pmid = 10971658 | doi = 10.1046/j.1526-4610.2000.040008629.x | s2cid = 14443890 }}</ref><ref>{{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | author = Medical Advisory Secretariat | title = Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis | journal = Ontario Health Technology Assessment Series | volume = 10 | issue = 26 | pages = 1–57 | year = 2010 | pmid = 23074404 | pmc = 3377587 }}</ref> This requires that other concerning findings such as [[papilledema]] (swelling of the optic disc) are not present. People with migraine are not at an increased risk of having another cause for severe headaches.{{Citation needed|date=November 2023}}