Care begins with a thorough evaluation designed to find the factors behind your migraine, not just to confirm the diagnosis.

Your history

Expect detailed questions about your attacks (frequency, phases, aura, triggers, timing), sleep, diet, caffeine, stress, menstrual cycle and hormones, past head injuries, medications and supplements, and what you have already tried.

Questionnaires that measure impact

Standardized questionnaires turn your experience into numbers that can be tracked:

• MIDAS (Migraine Disability Assessment): how many days migraine has affected work, home and social life over 3 months ¹.
• HIT-6 (Headache Impact Test): the overall impact of headache on daily life ^2,3.
• MSQ (Migraine-Specific Quality of Life): how migraine limits your activities and emotions ⁴.
• Headache diary: headache days, severity, and medication use. See the diary template.

The physical and neurological exam

The exam may include:

• Vital signs such as blood pressure in both arms and oxygen levels
• Eye movements: tracking, quick jumps (saccades), focusing up close (convergence), and keeping vision steady while the head moves. Eye movement differences are common in migraine ^5,6.
• Vestibular and balance tests, including standing and stepping tests and responses to visual motion ⁷. After concussion, a screening like VOMS may be used ⁸.
• Neck and jaw: range of motion, muscle tenderness and joint function ⁹.
• The Harcourt Method (described below)

The Harcourt Method

This is a simple, dynamic test Dr. Harcourt developed to help confirm findings after a full exam. You focus on a target at least an arm’s length away while the clinician slowly moves your head side to side and up and down in different positions. The clinician notes any resistance, small tremors or difficulty. Because this simultaneously challenges the eye muscles, the balance canals of the inner ear and the cerebellum, it helps pinpoint which directions of movement need work. Exercises are prescribed based on those directions and re-tested after about two weeks.

Lab testing

Depending on your history, blood tests may check levels like vitamin D, B12, folate and magnesium ^10,11. Hormone testing may also be recommended. See Hormones: testing and balance.

Research cited on this page

1. Benz T, Lehmann S, Gantenbein AR, et al. Translation, cross-cultural adaptation and reliability of the German version of the migraine disability assessment (MIDAS) questionnaire. Health Qual Life Outcomes. 2018;16(1):42. PubMed 29523138 · DOI
2. Yang M, Rendas-Baum R, Varon SF, et al. Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraine. Cephalalgia. 2011;31(3):357-67. PubMed 20819842 · DOI
3. Rendas-Baum R, Yang M, Varon SF, et al. Validation of the Headache Impact Test (HIT-6) in patients with chronic migraine. Health Qual Life Outcomes. 2014;12:117. PubMed 25080874 · DOI
4. Rendas-Baum R, Bloudek LM, Maglinte GA, et al. The psychometric properties of the Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ) in chronic migraine patients. Qual Life Res. 2013;22(5):1123-33. PubMed 22797868 · DOI
5. Cambron M, Anseeuw S, Paemeleire K, et al. Saccade behaviour in migraine patients. Cephalalgia. 2011;31(9):1005-14. PubMed 21628442 · DOI
6. Wilkinson F, Karanovic O, Ross EC, et al. Ocular motor measures in migraine with and without aura. Cephalalgia. 2006;26(6):660-71. PubMed 16686904 · DOI
7. Granston A, Drummond PD. Painful stimulation of the temple during optokinetic stimulation triggers migraine-like attacks in migraine sufferers. Cephalalgia. 2005;25(3):219-24. PubMed 15689198 · DOI
8. Mucha A, Collins MW, Elbin RJ, et al. A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med. 2014;42(10):2479-86. PubMed 25106780 · DOI
9. Szikszay TM, Hoenick S, von Korn K, et al. Which Examination Tests Detect Differences in Cervical Musculoskeletal Impairments in People With Migraine? A Systematic Review and Meta-Analysis. Phys Ther. 2019;99(5):549-569. PubMed 30690564 · DOI
10. Rapisarda L, Mazza MR, Tosto F, et al. Relationship between severity of migraine and vitamin D deficiency: a case-control study. Neurol Sci. 2018;39(Suppl 1):167-168. PubMed 29904877 · DOI
11. Togha M, Razeghi Jahromi S, Ghorbani Z, et al. Serum Vitamin B12 and Methylmalonic Acid Status in Migraineurs: A Case-Control Study. Headache. 2019;59(9):1492-1503. PubMed 31471907 · DOI