Nearly all Headache seen in Primary Care is Migraine – (10-10-02)

Based on this article, I’m sure that I could go to my PCP right now with the headache I am experience as a result of beating my forehead against the computer screen and it would promptly be diagnosed as migraine. I’m sorry, this is a very biased opinion, but I started to believe that headaches are no longer a diagnosis that should be handled within mainstream medicine. Sure, we need to rule out aneurysms and tumors, but that’s well within the scope and competence of most chiropractors. Currently, and I’m sure this will change at some point in the future, but I have achieved 100% resolution of all headache patients in my office that have listened to all the recommendations and lifestyle changes necessary. And I can’t begin to tell you how many of those patients were given a diagnosis of migraine by previous doctors. Ironically, although most of these patients came in with multiple types of headaches (which is very, very common), true migraines are quite rare in my office. Needless to say, this article just plain floors me. One question I do have is, in the physical exam given, does anyone actually ever touch the neck????????

14th Migraine Trust International Symposium.

The overwhelming majority of people who visit their primary care physician complaining of episodic headache have migraine, but an inaccurate patient self-diagnosis can lead to mis-classification, researchers said at the 14th Migraine Trust International Symposium on Tuesday. Dr. Stewart Tepper, from the New England Center for Headache in Stamford, Connecticut, reported an analysis of findings from the 14-country, multicenter Landmark study, which enrolled 1,217 patients attending a primary care physician with a complaint of headache. At the beginning of the study, each patient made a self-diagnosis, and was given a diagnosis by their doctor. They then kept diaries for each of their next six headache attacks. The diaries of around 400 patients with newly diagnosed migraine or non-migraine headache were reviewed by Dr. Carl Dahlhof from Sweden, Dr. Andrew Dowson from the UK, Dr. Larry Newman from the US and Dr. Tepper. The panel assigned a diagnosis based on International Headache Society criteria. Ninety-four percent had either migraine or migrainous headaches, Dr. Tepper said. “If a patient comes in and complains of episodic migraine and the exam’s normal, it’s migraine until proven otherwise,” he told Reuters Health. The expert panel then looked at the correlation between the primary care physician’s diagnosis, the patient’s self-diagnosis and the diagnosis based on the analysis of the six diary entries. “If the GP diagnosed the patient as having migraine then 98% of the time the GP was correct. If the patient diagnosed themselves as having migraine, there was a high chance they were right,” Dr. Tepper said. “However, where things went awry was if primary care doctors diagnosed non-migraine. Then there was an 80% likelihood the patient had migraine. If the patients self-diagnosed non-migraine, there was an 85% likelihood the patient had migraine.” Several factors were linked to the misdiagnosis, but the most important seemed to be an inaccurate self-diagnosis by the patient, he said. “If the patient said to the GP I don’t think I’ve got migraine, then the GP would say OK. It didn’t seem to matter about the intensity of the headache or the frequency of the headache, it was what the patient said the headache was that drove the diagnosis.” Dr. Dowson commented, “These were very remarkable findings, we were not in any way expecting this.” He noted that only migraine was commonly severe enough to make people visit their doctor. “We know there are many, many hurdles for patients to get to the doctor and then to get the message across, so what we’re saying here is that tension-type headache is not severe enough to make people go and see their doctor and jump those initial hurdles. If someone comes in and says that they’re having problems with their headaches, probably one of the first questions you should ask is, are these headaches that stop you doing things? Does it actually affect your quality of life? If the answer’s yes, they’re liable to be migraine.”


James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.