Diagnosis

• A transformed migraine is usually more consistent in its severity and its location than a rebound headache.
• Transformed migraines are less sensitive to triggers than rebound headaches.

Differentiating Transformed from Tension Headaches. Once rebound headache is ruled out, the doctor must then differentiate natural transformed migraines from tension headaches:

• In most cases of transformed migraine (but not tension headache), gastrointestinal or neurologic symptoms are present.
• Transformed migraine is also frequently associated with menstrual fluctuations in women.

Imaging Tests

Imaging tests of the brain may be recommended under the following circumstances:

• If the results of the history and physical examination suggest neurologic problems.
• For patients with headaches that wake them at night.
• For new headaches in the elderly. In this age group, it is particularly important to first rule out age-related disorders, including stroke, hypoglycemia, hydrocephalus, and head injuries (usually from falls).
• For patients with worsening headaches.

They are not recommended for patients with migraine and with no other abnormal indications.

The following tests may be used:

• A CT (computed tomography) scan may be ordered to rule out brain disorders or headaches caused by chronic sinusitis.
• X-rays and other tests may also be used if sinusitis is strongly suspected.
• A neck x-ray can reveal arthritis or spinal problems.
• Other imaging tests include an MRI (magnetic resonance imaging), EEG (electroencephalogram), lumbar puncture, ultrasound testing, and cerebral angiography, positron emission tomography (PET), and single-photon emission computed tomography (SPECT). These tests are only performed if there is reason to suspect an underlying disease or as part of clinical studies.