diagnosis

diagnosis

Effective treatment is only possible if the condition is precisely identified. 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 determined through a thorough discussion of the symptoms between doctor and patient.

Furthermore, the patient's entire medical history must, of course, be reviewed, and a general and neurological examination must be performed. This forms the basis for a relationship of trust between the patient and the treating physician: 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 one headache

Typically, a patient suffers from not just one, but two or even more types of headaches. Therefore, the patient needs to know which specific type of headache to treat with which measure. The headache patient must be enabled to use the recommended therapy for each type of headache independently, even outside of a doctor's office.

For this reason, not only the doctor but also the patient needs to be familiar with the diagnostic criteria for the different headache disorders. To this end, the patient should be provided with a headache questionnaire, a headache diary, informational materials, and a list of patient guides. Ideally, a treatment passport should also be included, providing information on the characteristics of the most important types of headaches, a headache diary, and, on the last pages, an opportunity to outline the various treatment options for the different types of headaches.

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

No diagnostic zigzags whatsoever

A common mistake in migraine therapy is unfortunately that the patient becomes uncertain about their diagnosis. Many doctors repeatedly order further diagnostic procedures during the course of treatment. For example, the sinuses, eyes, temporomandibular joint, or cervical spine are examined again. The patient then immediately notices that the doctor is unsure of their diagnosis, since otherwise no further examinations would be necessary. Logically, a patient's motivation to engage in therapeutic measures—which are obviously based on uncertain ground—is low. Either you have migraines or you don't. Therefore, doctor and patient must agree on a diagnosis before starting therapy and then follow a consistent course. Changes are only justified if new headache characteristics emerge.

The diagnosis of migraine

I've already explained the main forms of migraine: migraine with and without aura. I've also mentioned that there are cases where the aura symptoms last longer than usual and thus extend into the headache phase. You also know now that migraine can occur without any headache at all, with only aura symptoms. Before you learn about other forms of migraine, let me say something fundamental about them.

This categorization into "pigeonholes" is an attempt to diagnostically manage a condition as diverse as migraine. However, we should always bear in mind that migraine doesn't care about classification at all. In other words, the dividing lines drawn here don't exist in the reality of the illness. They blur at the edges, become indistinct, and overlap. The textbook migraine, or the classification of the International Headache Society, is a helpful toolbox for diagnoses, not nature itself. The "textbook migraine" must always be measured against the patient's experience, not the other way around.

This link will take you to the current classification of the International Headache Society in its second edition.

You can find information on the different types of migraine here.

If you suffer from headaches, you should keep a diagnostic headache diary. If you do this diligently, you can continuously identify the type of headache you experience and discuss it with your doctor.

You can retrospectively enter your experiences into the diagnostic headache questionnaire. It will help you determine whether you suffer from migraines or tension-type headaches.