What is the role of lab testing and imaging studies in the evaluation of migraine headache?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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The choice of laboratory and/or imaging studies is determined by the individual presentation. For example, in an older person with compatible findings (eg, scalp tenderness), measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be appropriate to rule out temporal/giant cell arteritis. Visual field testing should be performed in patients with persistent visual phenomena.

The development of an objective, quantitative biologic measurement of headache-pain severity could help to improve the diagnosis of migraine and enable more accurate assessments of treatment efficacy. In a study by Nguyen et al, as previously mentioned, quantitative sensory testing found significant differences in the perception of vibrotactile stimulation in patients with migraine compared with controls, including stimulus amplitude discrimination, temporal order judgment, and duration discrimination. [55]

A 2013 study suggested that high peripheral blood levels of calcitonin gene-related peptide (CGRP), a neurotransmitter that causes vasodilation, can aid in the diagnosis of chronic migraine by serving as a biomarker for permanent trigeminovascular activation. The migraine patients in the study had a CGRP level of 74.90 pg/mL, significantly higher than those in the other participants. Blood samples in the study were obtained between, rather than during, migraine attacks. Additionally, patients with chronic migraine with a history of aura had significantly higher CGRP levels than chronic migraine sufferers who had never experienced an aura. [75, 76, 77]

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