Unifying Concepts

Diagnostic Criteria for Migraine (ICHD-3)

The ICHD-3 provides diagnostic criteria for the three main categories of migraine: migraine without aura, migraine with aura, and chronic migraine.

Criteria Migraine without aura

At least five attacks that meet the following four criteria:

  1. Headache lasting 4-72 hours (when untreated or unsuccessfully treated)
  2. Headache with at least two of the following four characteristics:
    • Unilateral location
    • Pulsating quality
    • Moderate or severe pain intensity
    • Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
  3. Headache accompanied by at least one of the following symptoms:
    • Nausea, vomiting, or both
    • Photophobia and phonophobia
  4. Not better accounted for by another ICHD-3 diagnosis

Migraine with aura

At least two attacks that meet the following three criteria:

  1. One or more of the following fully reversible aura symptoms:
    • Visual
    • Sensory
    • Speech, language, or both
    • Motor
    • Brain stem
    • Retinal
  2. At least three of the following six characteristics:
    • At least one aura symptom spreading gradually over a period ≥5 minutes
    • Two or more aura symptoms occurring in succession
    • Each aura symptom lasting 5–60 minutes
    • At least one unilateral aura symptom
    • At least one positive aura symptom
    • Headache accompanying the aura or following the aura within 60 minutes
  3. Not better accounted for by another ICHD-3 diagnosis

Chronic migraine

Headaches (suggestive of migraine or tension headaches) on ≥15 days/month for >3 months that fulfill the following criteria:

  1. Occurring in a patient who has had at least five attacks meeting the criteria for migraine without aura or the criteria for migraine with aura or both
  2. On ≥8 days/month for >3 months, features of migraine without aura or of migraine with aura or believed by the patient to be migraine at onset that is relieved by a triptan or ergot derivative
  3. Not better accounted for by another ICHD-3 diagnosis



  1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. [Medline]
  2. Ashina M. Migraine. N Engl J Med 2020; 383:1866-1876. [Medline]


Created Nov 12, 2020.

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