Synopsis
Diagnose migraine positively from its episodic phenotype, distinguish typical aura from vascular or epileptic mimics, and recognise when a changing pattern needs secondary-headache investigation.
- Migraine is a positive clinical diagnosis: recurrent attacks commonly last 4–72 hours and combine moderate or severe headache with nausea or sensitivity to light and sound.
- The pain may be unilateral or bilateral, often pulsating and aggravated by routine activity, but no single descriptor is required when the overall pattern is characteristic.
- Typical aura is fully reversible visual, sensory or speech disturbance that develops gradually over at least 5 minutes and usually lasts 5–60 minutes for each symptom.
Key red flags
Motor weakness, diplopia, monocular visual symptoms, reduced consciousness or impaired balance requires further assessment because it falls outside straightforward typical-aura diagnosis.
Investigation priorities
Make a positive migraine diagnosis and identify a meaningful change or secondary-headache feature.
Management branches
A person reports episodic headache with or without transient neurological symptoms.
- Establish duration, frequency, onset speed, pain behaviour, nausea, sensory sensitivity, disability and complete recovery, then compare every feature with previous attacks.
- For neurological symptoms record whether phenomena were positive or negative, gradual or abrupt, sequential or simultaneous, and fully reversible within the expected duration.