At the beginning there is the diagnosis



Effective treatment is only possible if the disease is precisely known. This means that a detailed diagnosis must first be made according to the criteria of the International Headache Society. Whether the criteria for the respective category are met can only be found out through a detailed discussion between doctor and patient about the symptoms.

In addition, of course, the patient's entire medical history must be examined and a general and neurological examination must be carried out. This is the basis for a relationship of trust between the patient and the treating doctor: If the patient feels that they and their illness are being taken seriously, they will also be willing to actively participate in prevention. Understandably, this cannot be achieved in a ten-minute conversation.

Usually more than a headache

Typically, the patient suffers from not just one, but two or even more types of headache. For this reason, the patient must know which type of headache he should specifically treat with which measure. The headache patient must be able to use the recommended therapy for the respective type of headache outside of the office without a doctor.

For this reason, not only the doctor needs to know the diagnostic criteria for the different headache disorders, but also the patient. To do this, the patient must be given a headache questionnaire, headache calendar, information material and a list of patient guides. It is also ideal to have a treatment card that provides information about the characteristics of the most important types of headache, includes a headache calendar and, on the last pages, offers the opportunity to outline the various therapy suggestions for the different types of headache.

It is impossible for the patient to understand and remember all the information about the different types of headaches and their treatment in different situations during a consultation session. For this reason, the doctor must ensure that written notes are made during the consultation, which the patient can then take home.

Just no diagnostic zigzags

Unfortunately, a common mistake in migraine therapy is that the patient becomes confused about his diagnosis. Many doctors repeatedly initiate further diagnostic measures during the course of treatment. Then, for example, the nasal sinuses, eyes, jaw joint or cervical spine are examined again. Of course, the patient immediately notices that the doctor is not sure about his diagnosis, otherwise he would not need any further examinations. However, a patient's motivation to engage in therapeutic measures - which are obviously on uncertain ground - is logically low. You either have a migraine or you don't have a migraine. Doctors and patients must therefore decide before starting therapy and then take a consistent path. Changes are only warranted when new headache features emerge.

The diagnosis of migraine

I have already explained to you the main types of migraines: migraines with and without aura. It has already been mentioned that there are cases in which the aura symptoms last longer than usual and thus extend into the headache phase. You now also know that migraines can occur without any headache and only with aura symptoms. Before you learn about other types of migraines, let me say something basic.

This division into “drawers” ​​is an attempt to get a diagnostic grip on such a diverse clinical picture as migraine. But we should always keep in mind that migraines don't care at all about classification. In other words: the dividing lines drawn here do not exist in the reality of the disease. They blur at the edges, become out of focus, overlap each other. The migraine from the textbook or the classification of the International Headache Society is a helpful box for diagnoses, not nature itself. The “picture-book migraine” must always be measured by the patient's experience, not the other way around.

Under this link you will find the current classification of the International Headache Society in the current second edition.

You can find the individual types of migraine here

If you are affected yourself, you should keep a diagnostic headache calendar. If you do this diligently, you can continually determine your headache type and discuss it with your doctor.

You can retroactively enter your experiences in the diagnostic headache questionnaire. It will help you determine whether you are suffering from a migraine or tension-type headache.