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 headache
complaints, 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 and
Combined 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 as
a 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 IBM
SPSS 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 of
age with 32% males and 68% females. Seventy seven of those patients reported more than 4 acute attacks of
headache per 6 months which compelled them to visit their nearest ER. The participants were divided
according 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. After
managing their acute attack in the ER, the patients were referred to various departments for respective
treatment protocols. After 6 months of follow-up, 54.7% of the patients reported a reduction in visits to the ER
for acute episodes of headache.
Conclusion: There is an increased tendency to label and treat patients with any headache as migraine which
results in the administration of unnecessary analgesia which may have serious effects on health.