eMedicine Specialties > Neurology > Headache and Pain

Migraine Headache: Differential Diagnoses & Workup

Author: Jasvinder Chawla, MBBS, MD, MBA, Chief of Neurology, Hines Veterans Affairs Hospital; Associate Professor and Director, Neurology Residency Training Program, Loyola University Medical Center
Contributor Information and Disclosures

Updated: Sep 4, 2008

Differential Diagnoses

Arteriovenous Malformations
Muscle Contraction Tension Headache
Cerebral Aneurysms
Oligodendroglioma
Childhood Migraine Variants
Persistent Idiopathic Facial Pain
Chronic Paroxysmal Hemicrania
Pituitary Tumors
Cluster Headache
Polyarteritis Nodosa
Craniopharyngioma
Postherpetic Neuralgia
Dissection Syndromes
Subarachnoid Hemorrhage
Glioblastoma Multiforme
Systemic Lupus Erythematosus
Headache: Pediatric Perspective
Temporal/Giant Cell Arteritis
Herpes Simplex Encephalitis
Tolosa-Hunt Syndrome
Intracranial Hemorrhage
Viral Encephalitis
Meningioma
Viral Meningitis
Meningococcal Meningitis
Migraine Headache: Pediatric Perspective
Migraine Variants

Other Problems to Be Considered

Cerebral venous thrombosis

Workup

Laboratory Studies

Diagnostic investigations are performed for the following reasons:

  • Exclude structural, metabolic, and other causes of headache that can mimic or coexist with migraine
  • Rule out comorbid diseases that could complicate headache and its treatment
  • Establish a baseline for treatment and exclude contraindications to drug administration
  • Measure drug levels to determine compliance, absorption, or medication overdose

Imaging Studies

  • Neuroimaging is indicated for any of the following:
    • First or worst headache of the patient's life
    • Change in frequency, severity, or clinical features of the headache
    • Abnormal neurological examination
    • Progressive or new daily, persistent headache
    • Neurological symptoms that do not meet the criteria for migraine with typical aura or that themselves warrant investigation
    • Persistent neurologic deficit
    • Hemicrania that is always on the same side and associated with contralateral neurological symptoms
    • Inadequate response to routine therapy
    • Atypical clinical presentation
  • Neuroimaging studies that may be appropriate include CT scan and MRI. Other studies such as angiography, MRA, and MRV also may be indicated. See History for more information on selection of imaging studies.
  • Agarwal et al have described reversible MRI brain white matter abnormalities in a patient with migraine.4

Procedures

  • Indications for LP include the following:
    • First or worst headache of a patient's life
    • Severe, rapid-onset, recurrent headache
    • Progressive headache
    • Atypical chronic intractable headache
  • Neuroimaging (CT scan or MRI) should precede LP to rule out a mass lesion and/or increased ICP.

More on Migraine Headache

Overview: Migraine Headache
Differential Diagnoses & Workup: Migraine Headache
Treatment & Medication: Migraine Headache
Follow-up: Migraine Headache
Multimedia: Migraine Headache
References
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References

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Further Reading

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Keywords

complex migraine, migraine equivalent, migraine variant, classic migraine, cluster headache, aura

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Contributor Information and Disclosures

Author

Jasvinder Chawla, MBBS, MD, MBA, Chief of Neurology, Hines Veterans Affairs Hospital; Associate Professor and Director, Neurology Residency Training Program, Loyola University Medical Center
Jasvinder Chawla, MBBS, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Joseph Quinn, MD, Assistant Professor, Department of Neurology, Portland VA Medical Center, Oregon Health Sciences University
Joseph Quinn, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

 
 
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