By Dr. Anthony Policastro

Headache is a common presenting symptom at any age. One of the common types of headaches is migraine headaches, which can range in severity.

The question is often how to tell if someone is having migraines or another type of headache. There is no sure-fire lab exam. Therefore, the diagnosis relies on taking a good history.

The best way to do that is to be consistent about it. Asking the same set of questions each time will help define a clinical picture that makes migraine more likely.

I developed my own mnemonic for asking questions of pediatric patients with headaches. The mnemonic was FARRAH.

I would begin with Family History. Migraine is a hereditary disorder. It is more common in both of a pair of identical twins than it is in fraternal twins. As we identify more of the human genome, we are beginning to find genes that are migraine related.

The second criterion is something called Aura. This refers to the fact that individuals with migraines sometimes experience pre-headache symptoms. Sometimes these take the form of visual signs like lights appearing. Sometimes they may take the form of a tingling sensation. Individuals who experience these things can tell that a migraine is coming. They occur in about 20 percent of migraine sufferers.

The third criterion is Recurrent. Migraines are not a one time thing. Once they start, they tend to recur multiple times in the same person.

The fourth criterion is that they felt thRobbing in nature (yes that R is cheating a little). It is almost like the individual can feel a pulse beat in his/her head.

The fifth criterion is Abdominal symptoms. Individuals with migraine may have abdominal pain. They might have vomiting. There are actually some people who have what are called abdominal migraines. These can occur even without headaches. That makes the diagnosis more difficult.

The last criterion is called Hemicrania. This means that only one half of the head is involved in the headache. It is usually in the front of the head on one side or another. It tends to affect the same side repeatedly.

Treating migraine headaches is often complex. Mine respond to just acetaminophen. However, I have two daughters whose migraine treatment is much more complicated.

The problem is that you cannot treat them until you make the diagnosis. That is where the components of FARRAH come in. Using a consistent approach tends to make the diagnosis a little easier.