If imaging is deemed necessary, clinicians should remember that magnetic resonance imaging (MRI) is preferable to computed tomography (CT), with the exception of emergency settings.

When in doubt about whether imaging is necessary, Maureen Moriarity, BS, MS, DNP, of the Headache Center at Georgetown University Hospital in Washington, D.C., said clinicians can rely on SNOOPS.

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For more information on how to diagnose migraine, clinicians should refer to criteria from the International Headache Society, the International Classification of Headache Disorders, 3rd edition (ICHD-3 beta). Recent changes to the criteria have simplified the characteristics for headache to be considered migraine and include the following:

  • Headache for 15 days or more per month, with at least 8 of these days being migraine days
  • Headaches must last for 4 hours or more per day
  • Can occur with or without medication overuse

“We used to have to rule out medication overuse headache, which could take 3 to 6 months while you weaned the patient off of the medication, but you don’t have to with these criteria,” said Mallick-Searle.

The new criteria were first published in 2013, and are currently in a field-testing phase. However, the IHS recommends clinicians use the ICHD-3 beta while the criteria are finalized. The full ICHD-3 beta criteria are available in Cephalalgia.


  1. Mallick-Searle T. “Migraine: Updates in Diagnosis & Treatment.” Presented at: AANP 2015. June 10-14; New Orleans, Louisiana.