What's involved in a migraine exam?

When you start treatment for migraines, switch doctors or neurologists, or try a new treatment plan, you will most likely need to take a physical and/or neurological exam. This exam helps your doctor to detect possible contributing factors to your headaches, and to rule out more serious problems.

You can expect to be asked a lot of questions on your past medical and migraine history, especially if you have had any sort of head trauma in the past. Make sure you bring with you, or that your doctor has access to, your medical records, even if they aren't directly related to your headaches.

Your neurologist will then ask you such questions as:

What medications you are taking (for anything, not just migraines).
Drug interactions are important to keep in mind, and your doctor will need to know what medications you are on before prescribing medications for your migraines.
What factors seem to influence or trigger your headaches.
This can include environmental factors, smoking, eating or drinking certain foods, sleep patterns, stress factors, work environment and schedules, etc.
Where your headaches are located and the nature of the pain.
Your doctor will want to know where the pain starts and where it goes, how long the headaches last, and how fast they come on.
What helps lessen your headaches and how you feel after a headache goes away.
This can be helpful in creating an appropriate treatment plan.
Questions about your medical history.
This is information which can help your doctor assess the problem and determine the best course of action. Seemingly unrelated illnesses or conditions can have an effect on the treatment plan offered or medications prescribed for your headaches.
Whether or not any of your family members have migraines.
Migraines often seem to "run in the family", and knowing your family members' history of migraines and the methods used to treat them can help in determining the best course of action for you as well.
What other treatments you have used for migraine in the past.
If you have been treated for migraine by another physician, tell your doctor what types of treatment you have tried and how successful each of them were. This can help avoid unnecessary retracing of steps and give your doctor some insight into your past treatment plans.
Mental capability questions.
Your doctor may start asking you such seemingly silly questions as your name, where you are, what date and year it is, simple arithmetic, memory retention questions, interpreting common sayings, etc. This is not because your doctor thinks your headaches are psychological, but rather to make sure that certain areas of the brain are functioning properly.

Your doctor may then want to run some tests, which may include the following:

Physical examination.
Much like a regular physical exam, your doctor may want to examine your sinuses, scalp, jaw joints, eyes, eardrums, mouth, teeth, throat, neck and heart for any signs of other problems.
Cranial nerve examination.
Your doctor may examine the retina of your eye, and test your reflexes and motor strength and coordination.
Motor examination.
These tests may include pressing upwards against resistance, testing your reflexes, and flexing of muscles, walking around the room, and touching your finger to your nose.
Senory examination.
Tests your reaction to different stimuli. These tests often include pricking your skin with a pin, identifying letters traced on your hand, identifying objects in your hand while your eyes are closed, sensing a tuning fork on your wrists or ankles, and wiggling your toes.
Blood tests.
You will usually be asked to have your blood and/or urine tested to look for various medical problems. With some medications, you may also be asked to take blood tests periodically to measure the level of the medication in your system.
Electroencephalogram (EEG).
An EEG studies the functions of your brain using reflecting electrical patterns, which are converted and amplified by a machine to make a pattern that can be recorded on moving paper. Electrodes are pasted to your scalp and neck at various positions (it doesn't hurt but you look kind of silly). While you lie in a chair and relax, your brain wave patterns are recorded.
CAT (CT) scan.
The CAT scan is a painless form of x-ray which provides an excellent view of the cranium. Using a CAT scan, your doctor can detect problems such as hemorrhages, tumors, strokes and increased intercranial pressure. Basically, you lie down and part of a large machine spins around your head and photographically records your brain from various positions. The CAT scan is painless, but does expose you to a small amount of radiation (similar to an x-ray).
Magnetic Resonance Imaging (MRI).
MRI scans have better resolution and greater flexibility than CAT scans are particularly useful in diagnosing disorders of the brain and spine. MRIs are used to detect stroke, tumors, hemorrhages and areas of reduced blood flow (commonly found in patients with migraine). Abnormal blood vessels can also be detected with an MRI. You may need to be injected with a dye to enhance the accuracy of the test by increasing image contrast between abnormalities and normal brain tissue. You are closed in a chamber-like machine (let your technician know if you are clausterphobic), while the machine records pictures of your brain. The test is painless, and you might be able to listen to a radio or talk to a technician to help you through the closed-in feeling.

Your doctor might also want you to take an angiography (study of the blood vessels by injecting a contrast medium into the blood stream, which makes the blood vessels visible when x-rayed), a lumbar puncture or spinal tap (which allows measurement of spinal fluid pressure and collection of the fluid for evaluation by inserting a needle between two vertebrae in the lower back), or other tests.

By performing these tests, your doctor can get a clearer diagnosis of your problem, which in turn helps her to make a better decision on the course of treatment to take. However, the most important part of the overall examination is your medical and migraine history. Be honest and accurate with your doctor. Don't be afraid to describe your headaches in detail or include seemingly irrelevant facts. It's all another step on the road to recovery.

Resources: National Headache Foundation
Migraine: What Works, Joseph Kandel, MD and David B. Sudderleth, MD
Freedom From Headaches, Joel R. Saper, MD and Kenneth R. Magee, MD
Neurologist Online

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