What I heard from my neurology colleague, that migraine is usually a diagnosis by exclusion. That means if your physician suspects you have migraine, other investigations will be done to exclude that you don't have another diagnosis.
Why is it so until this time of high tech and advanced medical diagnostic tests?
I think, migraine is still a diagnosis of exclusion first because there’s not yet a definitive test or biomarker to show it’s present. Research is still ongoing. Also, the symptomatology of migraine overlaps with some other pressing conditions which requires rule out.
Article MRI findings in migraine. Rev Neurol Paris
Article Migraine and structural changes in the Brain: A systematic r...
There is certainly some evidence of structural and/or neurovascular differences in the brains of persons who either suffer from,or actively undergoing a migraine.
However,the main investigative tool remains that of MRI,which is both time consuming,and not always available during a sufferer's attack,and also difficult to interpret.
In some senses it does therefore continue as a diganosis of exclusion,not only beacuase of those difficulties,but also the need to exclude other more serious conditions.
Personally,I've had occasional migraines for many years,usually related to extreme tiredness,and the format is the classical aura followed by neurovascular symptoms including expressive dysphasia and paraesthesia.
Dear Mohamad-Hani, maybe the following papers will help you on the subject:
Kunkel RS. Migraine aura without headache: benign, but a diagnosis of exclusion. Cleve Clin J Med 2005;72(6):529-34. https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/issues/articles/content_72_529.pdf
Tinsley A, Rothrock JF. What Are We Missing in the Diagnostic Criteria for Migraine? Curr Pain Headache Rep 2018;22(12):84. https://link.springer.com/article/10.1007%2Fs11916-018-0733-1
Yang H, Zhang J, Liu Q, Wang Y. Multimodal MRI-based classification of migraine: using deep learning convolutional neural network. Biomed Eng Online 2018;17(1):138. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186044/pdf/12938_2018_Article_587.pdf
van der Meer HA, Visscher CM, Vredeveld T, Nijhuis van der Sanden MW, Hh Engelbert R, Speksnijder CM. The diagnostic accuracy of headache measurement instruments: A systematic review and meta-analysis focusing on headaches associated with musculoskeletal symptoms. Cephalalgia. 2019 Apr 18:333102419840777. doi: 10.1177/0333102419840777. [Epub ahead of print]. https://journals.sagepub.com/doi/pdf/10.1177/0333102419840777
Šukalo A, Merdžanović E, Alic A, Vrabac-Mujčinagić M, Alibašić E, Janković SM. Screening general practice patients for migraine without aura: construction and validation of the Balkan Migraine Screening Questionnaire (BMSQ). Med Glas (Zenica). 2019 Aug 1;16(2). doi: 10.17392/1021-19. [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pubmed/31127712
I consider not to be a diagnosis of excklusion. It should be diagnosed when the criteria of the IHS https://www.ichd-3.org are fullfilled. Of course the differentials have to be carefully thought of. But for the diagnosis you dont need an MRT, LP, EEG, ... It is a clinical diagnosis.
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