When evaluating a patient with suspected migraine, which examination should be performed?

When evaluating a patient with suspected migraine, which examination should be performed?

• A. Neuroimaging
• B. Blood tests only
• C. General medical and neurologic exam should be performed
• D. Psychiatric evaluation

Answer: (C)

Begin with a thorough general medical and neurologic examination to distinguish migraine from other headache causes and to identify any red flags suggesting a secondary cause. A complete neuro exam helps document baseline function, assess for focal deficits, and check cranial nerves, motor and sensory function, coordination, and signs of meningitis or intracranial issues. In typical, uncomplicated migraine, this exam often remains normal, which supports a primary headache diagnosis and guides management without immediate imaging. Neuroimaging and other tests aren’t routine unless red flags appear—such as sudden thunderclap onset, new headaches after age 50, progressive worsening, focal neurologic signs, fever with neck stiffness, or other systemic symptoms that raise concern for a secondary cause. Blood tests aren’t used to diagnose migraine and aren’t routinely needed unless history or exam points to another condition. Psychiatric assessment can be helpful if mood or anxiety disorders contribute significantly to the headache, but it isn’t the first step in evaluating suspected migraine.

Begin with a thorough general medical and neurologic examination to distinguish migraine from other headache causes and to identify any red flags suggesting a secondary cause. A complete neuro exam helps document baseline function, assess for focal deficits, and check cranial nerves, motor and sensory function, coordination, and signs of meningitis or intracranial issues. In typical, uncomplicated migraine, this exam often remains normal, which supports a primary headache diagnosis and guides management without immediate imaging. Neuroimaging and other tests aren’t routine unless red flags appear—such as sudden thunderclap onset, new headaches after age 50, progressive worsening, focal neurologic signs, fever with neck stiffness, or other systemic symptoms that raise concern for a secondary cause. Blood tests aren’t used to diagnose migraine and aren’t routinely needed unless history or exam points to another condition. Psychiatric assessment can be helpful if mood or anxiety disorders contribute significantly to the headache, but it isn’t the first step in evaluating suspected migraine.