The role of concomitant headache types and non‐headache co‐morbidities in the underdiagnosis of migraine.

Neurology. 2002;58(9 suppl 6):S3‐S9. That migraine is significantly underdiagnosed in the United States and other countries is well established. New data from a follow‐up survey to the American Migraine Study II reveal that the presence of concomitant headache types and co‐morbid conditions significantly affects the ability to detect and diagnose migraine. This article describes these data and explores the contribution of concomitant headache types and co‐morbidities to the problem of underdiagnosis of migraine. Migraine continues to be underdiagnosed because of failure to recognize it (missed diagnosis) and because of misdiagnosis of migraine as another headache type. First, a diagnosis of migraine may be missed in the presence of other headache types that occur proportionally more frequently than migraine and thereby overshadow migraine. Second, migraine may be misdiagnosed when health‐care providers inappropriately interpret specific symptoms and co‐morbid conditions as indicators of the presence of a non‐migraine headache type such as sinus or tension. By becoming aware of these diagnostic pitfalls and being more judicious and deliberate in diagnosing migraine and other headache types, health‐care providers can improve the diagnosis of migraine and patients to receive appropriate therapy. Comment: The diagnosis of migraine is less likely to be made if the patient has several types of headache presentations over time. Thus, a patient with the full spectrum of migraine, from episodic tension‐type through migrainous (probable migraine) headache and on to migraine per se is far less likely to receive a diagnosis of migraine than a patient who experiences attacks of “pure” migraine. SJT