How Doctors Diagnose Migraines Using Simple Tests

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

Do not suffer in silence. Talk with your doctor about your headaches. Brand New Images/Collection Vision/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 suffering from a migraine versus another type of headache.

P: Refers to the pulsating quality of a patient’s headache. Your doctor may ask you, "Is your headache throbbing?"
O: Refers to the duration of a patient’s headache, which is approximately one day for migraines — but can technically be anywhere between 4 and 72 hours. Your doctor may ask you, "How long do your headaches last?"
U: Refers to the unilateral location of a patient’s headache. Your doctor may ask, " Do your headaches occur on one side of your head?"
N: Refers to the presence of nausea or vomiting along with the head pain. Your doctor may ask, "Do you experience nausea and/or vomiting with your headaches?"
D: Refers to the disabling intensity of a headache. Your doctor may ask, "Do you miss work or school because of your 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 then the probability decreases to 64 percent, and 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 below. It focuses on three specific characteristics of migraines: nausea, photophobia (light sensitivity) and headache disability.
1.) Has a headache limited your activities for a day or more in the last three months?

2.) Are you nauseated or sick to your stomach when you have a headache?
3.) Does light bother you when you have a headache?

If you answer yes to two of the three questions, then the test is considered “positive” for a migraine. Based on a 2003 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 2011 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. Ruling out a migraine or a “negative” test means that you answer yes to none or only one of the questions.

What Does This Mean for Me?

Many of us have gone to see our primary care physician about headaches. We may have been misdiagnosed in the past with sinus headaches or tension headaches ​when we are really experiencing migraines or vice versa.​

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.


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.

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.

Wilson JF. In the clinic. Migraine [published correction appears in Ann Intern Med 2008;148(5):408]. Ann Intern Med. 2007;147(9):ITC11-1–ITC11-16.

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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