Do We Overdiagnose Migraine? A Prospective Study at Emergency Departments of Two Tertiary Care Hospitals

Abstract

Objective: To assess pathologies in patients previously diagnosed with migraine for their recurrent headachecomplaints, with an aim to uncover the misdiagnosis of migraine.Study Design: Prospective cohort study.Place and Duration of Study: The study was carried out at Emergency Departments of Military Hospital andCombined Military Hospital, Rawalpindi Pakistan from April 2018 to February 2019.Materials and Methods: This study is a prospective cohort study. Raosoft was used for sample size calculation.Non-probability convenient sampling technique was used. All patients included in the study were diagnosed asa case of migraine by a Medical Specialist /Neurologist and were already on treatment protocols for migraine.All patients with additional CNS pathology were excluded from this study. The data analysis was done using IBMSPSS for Windows version 25. Categorical Data was presented as percentages and frequencies.Results: One hundred thirty one patients participated in the study. The subjects ranged from 19 to 51 years ofage with 32% males and 68% females. Seventy seven of those patients reported more than 4 acute attacks ofheadache per 6 months which compelled them to visit their nearest ER. The participants were dividedaccording to possible causes after reassessment. Other causes included Hypertrophied Nasal Turbinates, DNS,Frontal Sinusitis, Septal Spur, TMJ disorders, Maxillary Sinusitis, Pansinusitis and Post Herpetic Neuralgia. Aftermanaging their acute attack in the ER, the patients were referred to various departments for respectivetreatment protocols. After 6 months of follow-up, 54.7% of the patients reported a reduction in visits to the ERfor acute episodes of headache.Conclusion: There is an increased tendency to label and treat patients with any headache as migraine whichresults in the administration of unnecessary analgesia which may have serious effects on health.