The International Headache Society has produced the following diagnostic criteria for migraine without aura:
| Point | Criteria |
|---|---|
| A | At least 5 attacks fulfilling criteria B-D |
| B | Headache attacks lasting 4-72 hours* (untreated or unsuccessfully treated) |
| C | Headache has at least two of the following characteristics: |
| • 1. unilateral location* | |
| • 2. pulsating quality (i.e., varying with the heartbeat) | |
| • 3. moderate or severe pain intensity | |
| • 4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs) | |
| D | During headache at least one of the following: |
| • 1. nausea and/or vomiting^^ | |
| • 2. photophobia and phonophobia | |
| E | Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder) |
^^In children, attacks may be shorter-lasting, headache is more commonly bilateral, and gastrointestinal disturbance is more prominent.
Migraine with aura (seen in around 25% of migraine patients) tends to be easier to diagnose with a typical aura being progressive in nature and may occur hours prior to the headache.
Typical visual auras may be:
These symptoms tend to develop over at least 5 minutes, last between 5–60 minutes, and are fully reversible.
Sensory symptoms may also occur.
If we compare these guidelines to the NICE criteria the following points are noted:
Auras may occur with or without headache and:
The following aura symptoms are atypical and may prompt further investigation/referral;