Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort

Viana, Michele; Khaliq, Fazli; Zecca, Chiara; Figuerola, María de Lourdes; Sances, Grazia; Piero, Vittorio Di; Petolicchio, Barbara; Alessiani, Michele; Geppetti, Pierangelo; Lupi, Chiara; Benemei, Silvia; Iannacchero, Rosario; Maggioni, Ferdinando; Jurno, Mauro Eduardo; Odobescu, S.; Chiriac, E.; Marfil, Alejandro; Brighina, Filippo; Uribe, Nelson Barrientos; Lago, Cristina Perez; Bordini, Carlos Alberto; Lucchese, Franco; Maffey, Vanessa Tello; Nappi, Giuseppe; Sandrini, Giorgio; Tassorelli, Cristina

doi:10.1111/ene.14098

Cited by 53 publications

(38 citation statements)

References 20 publications

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“…A third (and unfortunate) explanation could be the high cost associated with pharmacological or device treatments even for those with health insurance, or patient dissatisfaction with conventional health care providers and allopathic treatments (9,16). A fourth explanation could be inadequate physicianpatient communication and information about the cause and treatment of migraine (3,16). The category "Other" accounts for the majority of sources (Table 2) and reflects a broad diversity of authors with very different backgrounds.…”

Section: Discussionmentioning

confidence: 99%

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The migraine landscape on YouTube: A review of YouTube as a source of information on migraine

et al. 2020

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Introduction YouTube is the most widely used video hosting website in the world; however, the quality and reliability of information is unknown. The aim of this study is to evaluate the content and distribution of the most popular videos on YouTube about migraine. Methods We searched for migraine-related videos on the online video hosting resource YouTube ( http://youtube.com/ ). Two authors screened the titles and video descriptions independently for all videos with a view count of ≥ 10,000 views. For each video we recorded descriptive data, the source/author and the primary purpose/content. Results We identified 351 eligible videos. In total, there was more than 3 days of content viewed more than 163 million times. Only 9% of these videos were authored by healthcare professionals. The majority (44%) of videos focused on complementary and alternative medicine. Discussion YouTube provides a wide array of easily accessible information on migraine, ranging from authoritative sources to potentially questionable content. If used uncritically, this may result in inadequate clinical management. Peer-reviewed information on migraine mechanisms and treatment is needed to provide the best available evidence for the public and patients. Ideally, a professional society or foundation such as the International Headache Society would develop, curate, and distribute content.

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Section: Discussionmentioning

confidence: 99%

“…While the high prevalence of migraine suggests that there is readily available health information on the subject, migraine literacy appears to be poor (2). Furthermore, migraine continues to be poorly understood, underdiagnosed and undertreated (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

The migraine landscape on YouTube: A review of YouTube as a source of information on migraine

et al. 2020

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“…In all, 45% of patients attending with “headache” had a final diagnosis of a primary headache disorder, of which 68% were diagnosed with migraine and 28% TTH. This figure is likely to underestimate the actual number of migraine patients since it is very likely that many of those diagnosed with TTH or in the “benign headache” group may actually have migraine since physicians unfamiliar with headache may not take a detailed headache history and can often misdiagnose TTH due to lack of positive migrainous symptoms (e.g photophobia, phonophobia) if these are not specifically asked about (5–7). Also, if the headache is severe enough to warrant attendance to the ED, it is less likely to be TTH.…”

Section: Discussionmentioning

confidence: 99%

The burden of migraine on acute and emergency services in a London teaching hospital

Southwell

Afridi

2021

Cephalalgia

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Objective There is a lack of data on the burden of primary headache disorders such as migraine on emergency services. Existing data relies on a coding of “headache”, which encompasses both primary and secondary headache of all causes; for example, subarachnoid haemorrhage. Guy’s and St Thomas’ NHS Trust in London is one of the UK’s busiest emergency departments with 150,000 attendances per year. Our aim was to assess the healthcare resource utilisation of primary headaches, in particular migraine, in acute medical services. Methods We conducted an audit of all adult presentations to the emergency department of Guy’s and St Thomas’ Hospitals which were coded as “headache” over the first 6 months of 2018. We reviewed the initial diagnosis at presentation and also at discharge, investigations and outcome. Results Of 78,273 attendances to the emergency department, there were 976 presentations to the emergency department with “headache” as their primary complaint. “Migraine” was the most frequent of all diagnoses, accounting for 30% of all headache presentations and 25% of headache admissions. We calculated the cost of admitting and investigating migraine as £131,250 over the 6-month period. Conclusion Emergency admissions for migraine represent an avoidable cost and burden for both the hospital and the migraineur. This data informs us about the need to develop better care pathways for migraine in the community and to improve headache education for physicians and patients.

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“…Recommendations for local neck treatment are prevalent, 4,5 but evidence for the efficacy of neck treatment for migraine is limited 6 . Concurrently, neurologists are expressing frustration with misdiagnosis of cervicogenic headache and time and resources being spent on treating the neck, potentially delaying appropriate migraine management 7,8 . These issues denote an urgent need for better understanding of the origins of neck pain in migraine.…”

Section: Introductionmentioning

confidence: 99%

Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction

et al. 2021

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Objective To identify how frequently the neck pain associated with migraine presents with a pattern of cervical musculoskeletal dysfunction akin to cervical musculoskeletal disorders, and to determine if pain hypersensitivity impacts on cervical musculoskeletal function in persons with migraine. Background Many persons with migraine experience neck pain and often seek local treatment. Yet neck pain may be part of migraine symptomology and not from a local cervical source. If neck pain is of cervical origin, a pattern of musculoskeletal impairments with characteristics similar to idiopathic neck pain should be present. Some individuals with migraine may have neck pain of cervical origin, whereas others may not. However, previous studies have neglected the disparity in potential origins of neck pain and treated persons with migraine as a homogenous group, which does not assist in identifying the origin of neck pain in individuals with migraine. Methods This cross‐sectional, single‐blinded study was conducted in a research laboratory at the University of Queensland, Australia. Persons with migraine (total n = 124: episodic migraine n = 106, chronic migraine = 18), healthy controls (n = 32), and persons with idiopathic neck pain (n = 21) were assessed using a set of measures typically used in the assessment of a cervical musculoskeletal disorder, including cervical movement range and accuracy, segmental joint dysfunction, neuromuscular and sensorimotor measures. Pain hypersensitivity was assessed using pressure pain thresholds and the Allodynia Symptom Checklist. People with migraine with diagnoses of comorbid neck disorders were excluded. Cluster analysis was performed to identify how participants grouped on the basis of their performance across cervical musculoskeletal assessments. Post hoc analyses examined the effects of pain hypersensitivity on musculoskeletal function, and if any symptoms experienced during testing were related to musculoskeletal function. Results Two distinct clusters of cervical musculoskeletal function were found: (i) neck function similar to healthy controls (n = 108) and (ii) neck dysfunction similar to persons with neck pain disorders (n = 69). Seventy‐six of the individuals with migraine (62 with neck pain and 14 without neck pain) were clustered as having normal cervical musculoskeletal function, whereas the remaining 48 with neck pain had cervical dysfunction comparable with a neck disorder. Musculoskeletal dysfunction was not related to pain hypersensitivity or symptoms experienced during testing. Conclusions Neck pain when present with migraine does not necessarily indicate the existence of cervical musculoskeletal dysfunction. Skilled assessment without reliance only on the person reporting symptoms is needed to identify actual cervical dysfunction. Treatments suitable for neck musculoskeletal disorders would seem inappropriate for the individuals without cervical dysfunction. Future studies evaluating any potential effects of such treatments should only select participants...

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Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort

Cited by 53 publications

References 20 publications

The migraine landscape on YouTube: A review of YouTube as a source of information on migraine

The migraine landscape on YouTube: A review of YouTube as a source of information on migraine

The burden of migraine on acute and emergency services in a London teaching hospital

Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction

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