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Testing for migraines is variable. It may depend on what we're trying to rule out, more than actually diagnosing the migraines. Sometimes we're trying to make sure that there's nothing else that could be causing the headaches or head pain more than anything else. Such as strokes, tumors, blood, fluid, stuff like that in the brain. I do a variety of diagnostic testing. Some of it is very basic just to make sure there's no problems with kidney function, thyroid function, you're not anemic, any of those things that may not necessarily cause headaches, but it certainly is going to aggravate them or make them worse. Basic testing of the brain, including usually an MRI of the brain - usually with contrast to make sure there's nothing obvious causing the headaches - strokes, lesions, brain tumors, things like that.
Testing for migraines is variable. It may depend on what we're trying to rule out, more than actually diagnosing the migraines. Sometimes we're trying to make sure that there's nothing else that could be causing the headaches or head pain more than anything else. Such as strokes, tumors, blood, fluid, stuff like that in the brain. I do a variety of diagnostic testing. Some of it is very basic just to make sure there's no problems with kidney function, thyroid function, you're not anemic, any of those things that may not necessarily cause headaches, but it certainly is going to aggravate them or make them worse. Basic testing of the brain, including usually an MRI of the brain - usually with contrast to make sure there's nothing obvious causing the headaches - strokes, lesions, brain tumors, things like that.
I may or may not do an MRA of the brain and/or the neck, which is blood vessels - to check the blood vessels of the brain and neck. That depends on the history the patient gives me. I sometimes do an MRI of the cervical spine (the neck spine), again - it depends on the history the patient gives me. If their headaches tend to come from the neck upward or are triggered by certain neck movements, I may consider doing that. I may consider doing a lumbar puncture depending on the history the patient gives me or the type of headaches they're having - positional, stuff like that. If it's an atypical headache or there's a very strange presentation, I may consider doing an EEG. The diagnosis is made basically by clinical exam and ruling out any other possible causes to headaches or head pain.
The main thing to know is that migraines can be very complicated - not only in their causes but also in their treatment. Sometimes it's a multi-factoral approach. The first medication I try may or may not be helpful and we may have to meet multiple times in order to actually help you. Sometimes I may also ask you to put forth some effort in making sure that your lifestyle is not a cause and making sure that you're keeping a headache diary to see if I'm helping or not. We also need to make sure that we've ruled out some of the other common headache disorders and make sure that those are not mimicking migraine and I don't need those medications to treat what you currently have. I may ask you to do some diagnostic testing and treatment options as a trial to rule out other headache disorders. The most common one I'm asked about is medications and I break that down into two categories: abortive medications (which people think of as "what can I take right now because my headache is killing me?" and then prevention or prophylactic therapies (which are something you take every single day to ideally decrease the frequency and severity of the headaches.)
Preparing for your appointment: I ask a large variety of questions and sometimes patients are a little overwhelmed with the complexity of my questions, but I tend to ask when the migraines actually started, at what age, what type of headaches you may have, including any variety of different types of headaches. I may ask how frequent they are, where the pain is located, if anything obviously triggers them, if anything obviously makes the headaches better, what kind of medications you take, what kind of medications you may take to help the headaches if you've tried anything in the past to prevent them ( including even in the past 10 years or more.) If you've had any testing, if you've had any past medical history including even a head injury that may have triggered the headaches. I also want to know about your family's history. I would love it if patients brought a medication list, including the medications they're currently taking and the medications they've tried and failed in the past. That would help me tremendously so that I don't repeat history and make them try medications over and over again that they've already failed. I would love it if they brought me a headache journal telling me what their headaches are like over the past two, three, four months. I don't need anything complicated. Just write down: "It's a 7 out of 10." "It always hits in the morning." "It always hits when I'm exercising" or something like that. Or "it always hits around my menstrual cycle." Some sort of pattern so that I can figure that out.
Often patients with headaches are concerned that they might have a tumor or some other problem in their brain that is causing the headaches. Doctors will judge whether or not this is necessary based on a variety of of symptoms and and what we call signs. If the patient has any signs that there is a neurologic malfunction (which the doctor will pick up on examining the patient) then the patient will need an MRI of the brain. If there's a real new change that there are headaches that are much more severe or the patient never used to have headaches and now suddenly has headaches, then often the doctor will make the decision that they should check and make sure everything is fine with a brain. But many patients have had sporadic headaches throughout their life and if there's no real change, then there's not going to be a need to get an MRI.
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