How Doctors Diagnose Migraines Using Simple Tests

Diagnosing a Migraine Using a Mnemonic or Three-Item Screening Test

Doctors Use Screening Tests for Migraines
Doctors Use Screening Tests for Migraines. sturti/Getty Images

You may wonder how your doctor will diagnose your headache. You may even wish you could come to your doctor's appointment prepared, anticipating some of the questions she will ask.

Let's learn about two simple tests called the POUND mnemonic and the ID migraine questionnaire that many doctors use to diagnose a migraine.

What is the POUND Mnemonic?

After your doctor performs a history and physical examination—mainly to evaluate for headache warning signs—she may use this mnemonic to determine whether or not you are experiencing a migraine versus another type of headache.

P:  "Is your headache throbbing?" The "P" refers to the pulsating quality of a migraine.

O: "How long do your headaches last?" The "O" refers to the duration of a person’s headache, which is approximately one day for migraines but can technically be anywhere between 4 and 72 hours.

U: " Do your headaches occur on one side of your head?" The "U" refers to the unilateral location of a person’s headache.

N: "Do you experience nausea and/or vomiting with your headaches?" The "N" refers to the presence of nausea or vomiting along with the head pain.

D:  "Do you miss work or school because of your headache?" The "D" refers to the disabling intensity of the headache.

The likelihood that a person is having a migraine if they report 4 to 5 of the above symptoms is 92 percent. If a person has 3 of the 5 symptoms, the probability decreases to 64 percent. Finally, if a person has 0 to 2 of the above symptoms, the likelihood of a migraine is 17 percent.

The ID Migraine Questionnaire

This screening test consists of three "yes" or "no" questions and focuses on three specific characteristics of migraines:

  • nausea
  • photophobia (light sensitivity)
  • headache disability

The three questions are:

  • Has a headache limited your activities for a day or more in the last three months?
  • Are you nauseated or sick to your stomach when you have a headache?
  • Does light bother you when you have a headache?

If you answer "yes" to two of the three questions, the test is considered “positive” for a migraine.

Based on a study in Neurology, in 93 percent of cases in which this test was positive, a headache specialist also diagnosed a migraine, based on criteria from the International Headache Society.

Another study in Headache, which analyzed over 5000 patients from various clinics, found that the ID Migraine test was more useful for ruling out a migraine than ruling one in. Ruling out a migraine (which implies a negative test) means that you answer yes to zero or one of the above questions.

A Word From Verywell

Headaches are common complaints and it can be tricky distinguishing a migraine from another headache disorder like a tension headache or sinus headache

Here are two easy, rapid screening tools you as a patient can suggest to your doctor, or even complete prior to seeing your doctor, so that you are prepared for the visit. This way you and your doctor together can make an accurate diagnosis and implement an effective treatment plan.

Sources:

Cousins G. Hijazze S, Van de Laar FA, Fahey T. Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis. Headache. 2011. Jul-Aug;51(7):1140-8.

Ebell MH. Diagnosis of a migraine headache. Am Fam Physician. 2006;74(12):2087–2088.

Gilmore B, Michael M.Treatment of acute migraine headache. Am Fam Physician. 2011 Feb 1;83(3):271-80.

Lipton RB, Dodick D, Sadovsky R, Kolodner K, Endicott J, Hettiarachchi J, Harrison W. A self-administered screener for a migraine in primary care: The ID Migraine validation study. Neurology. 2003 Aug 12;61(3):375-82

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