CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Headache - assessment - Management
How do I diagnose tension-type headache and migraine?
- Exclude symptoms of serious secondary causes and other secondary causes of headache before considering a diagnosis of tension-type headache or migraine.
- Suspect migraine in people who present with a pattern of recurrent episodes of severe disabling headache associated with nausea and sensitivity to light, who have a normal neurological examination.
- Diagnose migraine without aura when there are recurrent episodes of headache, lasting between 4 hours and 3 days, that are characteristically:
- Unilateral.
- Pulsating in character.
- Moderate-to-severe in intensity.
- Aggravated by routine physical activity.
- Associated with either nausea or vomiting, or photophobia and phonophobia, or both.
- Diagnose migraine with aura when typical symptoms of migraine are preceded by the onset of an aura consisting of visual or sensory symptoms or dysphasia. Symptoms develop gradually and are fully reversed within 1 hour.
- Visual symptoms include flickering lights, spots, lines, or loss of vision.
- Sensory symptoms include pins and needles, or numbness.
- Suspect tension-type headache if the person presents with bilateral headache that is non-disabling and neurological examination is normal.
- Diagnose tension-type headache when there are recurrent episodes of headache, lasting between 30 minutes and 7 days, that are characteristically:
- Bilateral.
- Pressing or tightening in character.
- Mild-to-moderate in intensity.
- Not aggravated by routine physical activity.
- Not associated with nausea or vomiting.
- Sometimes associated with photophobia or phonophobia, but not both.
© NHS Institute for Innovation and Improvement