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Huma Sheikh, Amy Gonzales from Doctor Unite Commented on a Post
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How can we improve migraine diagnosis?

As few as half of all patients reporting migraine-like symptoms have been formally diagnosed with migraine headaches. Underdiagnosis and treatment may be due to atypical presentation with lack of the best-known symptoms of migraine. Migraines can also mimic other neurological, ocular, or even gastrointestinal conditions. Many patients with migraines are misdiagnosed with sinusitis or tension-type headaches, or suspected of having glaucoma, meningitis, epilepsy, a stroke, brain aneurysm, or a malignancy in the brain.  

In making your diagnosis, how do you differentiate between migraine and those neurological conditions that share similar symptoms?  How do you think more migraine patients can receive a correct diagnosis? 

  • October 18, 2022
    It is important to rule out secondary causes but it will most likely be migraine given how frequent and different the symptoms can be.
  • from Doctor Unite October 16, 2022
    We have always been taught since medical school and residency training to always rule out other serious causes of whatever symptom the patient is experiencing be it lets say headache, abdominal pain, back pain etc. Ruling out the diseases mentioned above and including them in the differential dx is always prudent. Migraine can be diagnosed by its characteristic presentation and this can be done by doing a thorough hx and physical exam.
  • from Doctor Unite October 12, 2022
    Migraine is most defintely is a very common day to day Disease process with great degreee of morbidity and there is lot of delay in diagnosis and at times pts get quite an extensive work up which causes more anxiety and the frustration , What needs to be realized that Migraine is a systemic disease and Headache part is just the tip of the Iceberg , Health Care Providers need to be well versed with the various patterns of Migraine and Differntial needs to be broadly classifed in to Vascaulr Vs Non Vascular Headaches in the work up of the Chronic Headaches and that is how the diagnosis needs to be narrowed down and at times trial of the specific Migraine therapy also gives a diagnostic clue
  • October 10, 2022
    In addition to the clinical descriptions shared above by my colleagues, several migraine screening questionnaires have been developed with reported good accuracy in assessing the likelihood that a patient's headaches are caused by migraines. Such screening tools could be used by primary care or other non-neurologist healthcare providers in helping to direct such patients for appropriate physician referral and optimal timely medical management. These screening tools include the following:

    The ID Migraine Questionnaire (Mattos et al, 2017):

    1. Has a headache limited your activities for a day or more in the last three months?
    2. Are you nauseated or sick to your stomach when you have a headache?
    3. Does light bother you when you have a headache?


    the POUND Questionnaire (Tejero et al, 2018):

    P: Is your headache throbbing? 
    O: How long do your headaches last? 
    U: Do your headaches occur on one side of your head? 
    N: Do you experience nausea and/or vomiting with your headaches? 
    D: Do you miss work or school because of your headache? 

    and the

    Migraine-Screen Questionnaire (MS-Q) (Láinez et al, 2010):

    1. Do you have frequent or intense headaches?
    2. Do your headaches usually last more than four hours?
    3. Do you usually suffer from nausea when you have a headache?
    4. Does light or noise bother you when you have a headache?
    5. Do your headaches limit any of your physical or intellectual activities?
  • from Generation NP October 10, 2022
    response to sumatriptan or a trial of Ubrelvy can be diagnostic as well.
  • from Doctor Unite October 09, 2022
    Remember a patient who presents with "sinus headache" often is migraine. A good history determines if the sinusitis diagnosis is possible. A trial of Ubrelvy can be diagnositic.
  • from Generation NP October 09, 2022
    The frequency, symptoms and treatability of migraine key in determining the diagnosis and ruling out of other possible diagnoses.
  • September 28, 2022
    I think the first comment is very misleading, migraine is very common, one of the top diagnosis causing morbidity in the world, it is more common than DM, and occipital neuralgia usually runs hand in hand with it likely as due to the oversensitization of peripheral nerves.
  • September 28, 2022
    Migraine is very common, it is more frequent than DM, I do not think that they are misdiagnosed from occipital neuralgia, they can also run hand in hand.
  • from Doctor Unite September 18, 2022
    Migraines are uncommon and are the misdiagnosis of occipital neuralgia. Touch the occipital nerve areas and if they are tender then the patient does not have a migraine. If we diagnosed and treated occipital neuralgia more often then migraine may even become rare.
  • from Generation NP September 18, 2022
    Characteristics of migraine such as aura, triggers, presence of nausea and photophobia, help to distinguish migraine from other headache conditions. A neurologic exam is always needed. Opthalmologic exam is important if eye pain, vision changes, etc. Also timing to be considered: onset during teen-age years, association with menstrual cycle and family history of migraines all point in favor of a diagnosis of migraines.