Migraine diagnostic criteria calculator

Migraine Diagnostic Criteria Calculator

Migraine diagnostic criteria calculator

Dr. Rao Khurram Ayoub - Pharmaceutics Specialist

Medically reviewed by Dr. Rao Khurram Ayoub, RPh, PhD (Pharmaceutics)

Written by Dr. Muhammad Imran, M.Phil, PharmD, BSc

Updated on

Clinical Assessment Tool

Migraine Diagnostic & Treatment Stratification Calculator (ICHD-3)

Evaluate headache symptoms against official ICHD-3 criteria, screen for secondary headache red flags, and stratify treatment based on validated disability scales.

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Before evaluating primary migraine, screen for features that may indicate a secondary headache disorder requiring neuroimaging or urgent referral. Dodick (2003): "Red flag features necessitate neuroimaging to rule out structural pathology."

STEP 1 — ICHD-3 Primary Migraine Diagnostic Criteria

How many similar headache attacks have you experienced in your lifetime?

When untreated (or unreliably treated), how long does a typical headache last?

Select all that apply (Minimum of 2 required):

Select all that apply (Minimum of 1 required):

Do you experience temporary visual changes (zigzag lines, blind spots) or sensory numbness lasting 5–60 minutes before pain starts?

STEP 2 — MIDAS Disability Assessment

Over the last 3 months, how many days did headaches cause the following? (Lipton et al., 2000 — stratifying acute care by disability improves outcomes.)

MIDAS Score: 0 — Grade I (Minimal Disability)

STEP 3 — HIT-6 Headache Impact Test

Over the last 4 weeks, how often did headaches cause the following? (Score each 1–5)

1. When you have headaches, how often is the pain severe?
2. How often do headaches limit your usual daily activities?
3. When you have a headache, how often do you wish you could lie down?
4. In the past 4 weeks, how often have you felt too tired to do work or daily activities because of headache?
5. In the past 4 weeks, how often have you felt fed up or irritated because of headache?
6. In the past 4 weeks, how often did headaches limit your ability to concentrate on work or daily activities?
HIT-6 Score: 36 — Little or no impact

STEP 4 — Medication-Overuse Headache (MOH) Screen

Diener et al. (2019): Overuse of acute medications for 10–15 days/month promotes central sensitization and headache chronification.

Incomplete Evaluation

Please complete all fields above to evaluate your symptoms against ICHD-3 diagnostic criteria.

Scientific References & Evidence Base

Headache Classification Committee of the IHS (2018) stated that 'diagnosis of migraine without aura requires at least five attacks lasting 4–72 hours fulfilling specific pain and symptom features, whereas migraine with aura requires at least two attacks with reversible focal neurological symptoms.'

Dodick (2003) stated that 'the presence of red flag features including systemic symptoms, neurological deficits, sudden onset, older age at onset, or pattern change necessitates neuroimaging to rule out underlying structural pathology.'

Lipton et al. (2000) stated that 'stratifying acute care based on baseline disability significantly improves treatment outcomes and pain freedom compared to stepped care.

Diener et al. (2019) stated that 'overuse of acute migraine medications for 10 to 15 days per month depending on drug class promotes secondary central sensitization and headache chronification.'

  1. Headache Classification Committee of the International Headache Society (IHS), 2018. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia, 38(1), pp.1–211.
  2. Dodick, D.W., 2003. Clinical clues and clinical rules: primary vs secondary headache. Advanced Studies in Medicine, 3(6), pp.S550–S555.
  3. Lipton, R.B., et al., 2000. Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) Study. JAMA, 284(20), pp.2599–2605.
  4. Diener, H.C., et al., 2019. Medication-overuse headache: risk factors, pathophysiology and management. Nature Reviews Neurology, 15, pp.535–547.
  5. Sacco, S., et al., 2024. European Academy of Neurology guideline on the management of migraine in adults. European Journal of Neurology, 31(7), p.e16307.
  6. Charles, A.C., et al., 2024. The American Headache Society Consensus Statement on Integrating New Antimigraine Therapies into Clinical Practice. Headache, 64(4), pp.333–357.
Interactive Tool Guide

How to Use the Migraine Diagnostic Calculator

Follow these four simple steps to evaluate whether your headache symptoms meet the international ICHD-3 clinical diagnostic criteria.

STEP 1
Log Attack History

Select the total number of lifetime headache episodes you have experienced (minimum of 5 required for baseline diagnosis).

STEP 2
Specify Duration & Pain

Indicate typical attack duration (4–72 hours untreated) and pain characteristics (throbbing, one-sided, moderate-to-severe).

STEP 3
Check Associated Features

Select accompanying symptoms such as nausea, vomiting, photophobia (light sensitivity), or phonophobia (sound sensitivity).

STEP 4
Review Results

Generate your clinical assessment report to share directly with your physician or pharmacist during your consultation.

Clinical & Patient Summary ICHD-3 Code: 1.1 & 1.2
🧑‍🌾 For Patients & Caregivers

Migraine is a neurovascular condition, not just a standard headache. It causes throbbing pain (often on one side), light sensitivity, and nausea lasting 4 to 72 hours.

🩺 For Physicians & Pharmacists

Requires ≥ 5 attacks meeting ICHD-3 criteria. First-line abortives: Triptans, NSAIDs, or CGRP antagonists (Gepants). Prophylaxis indicated if ≥ 4 headache days/month.

1. Diagnostic Matrix: Migraine vs. Other Primary Headaches

Feature Migraine Tension-Type Cluster Headache
Location Unilateral (60%) or Bilateral Bilateral ("Band-like") Strictly Unilateral (Orbital/Temporal)
Pain Quality Pulsating / Throbbing Dull, Tightening, Non-throbbing Excruciating, Sharp, Piercing
Duration 4 – 72 Hours 30 Minutes – 7 Days 15 – 180 Minutes
Associated Symptoms Nausea, Vomiting, Photophobia No nausea; rare photophobia Tearing, Nasal Congestion, Restlessness
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Red Flag Alert: When to Seek Immediate Emergency Care (SNOOP4 Criteria)

  • Systemic Symptoms: Fever, unexplained weight loss, or history of cancer/immunosuppression.
  • Neurological Signs: Confusion, weakness, numbness, speech difficulty, or vision loss.
  • Onset: Sudden "Thunderclap" onset (peaking within 60 seconds).
  • Older Age: New headache onset after age 50.
  • Pattern Change: Progressive worsening or major change in previous headache frequency/severity.
Patient Rescue Protocol

3-Step Acute Migraine Action Plan

What to do the moment you feel a migraine attack starting—or during the prodrome phase.

1 💊

Take Abortive Medication Early

Take your prescribed acute rescue medication (such as a Triptan or Gepant) or recommended OTC pain reliever at the first sign of pain or aura.

Tip: Abortive therapies are most effective when taken before severe pain develops.
2 🕶️

Retreat to a Low-Sensory Space

Move to a quiet, dark, and cool room. Turn off bright lights, step away from digital screens, and eliminate noise sources immediately.

Tip: Apply a cold compress or ice pack to your forehead or the back of your neck to dull sensory input.
3 💧

Hydrate & Rest Your System

Sip 16–24 oz of room-temperature water or an electrolyte solution. Lie down, close your eyes, and focus on slow, deep breathing to reduce physiological stress.

Tip: Avoid solid, heavy, or fatty foods if nausea is present.
⚠️ Medication Overuse Warning: Do not use abortive medications (triptans or combination NSAIDs) more than 10 days per month to avoid Medication Overuse Headaches (rebound pain).
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