Diagnosing Chronic Migraine: The Magic Question

The majority of chronic Migraine patients are not diagnosed correctly. A recent study showed that about 80% of participants who had chronic Migraine were not diagnosed properly.

Yes Virginia, there is a magical question for diagnosing chronic Migraine and your doctor may not be asking it.

Chronic Migraine is suspected when the patient is feeling head pain more days than not. Migraine and headache specialists use ICHD-II criteria to pin down a chronic Migraine diagnosis, but because we cannot test for chronic Migraine, this requires questioning the patient. How patients are questioned can make the difference between an accurate diagnosis and missing the mark. This is important because there are optional treatments for those patients who are properly diagnosed.

At the 2012 Scottsdale Headache Symposium in Arizona this past November, this vital point was brought up on multiple occasions by multiple presenters. Simply asking the patient “How many Migraine days per month do you have?” makes sense since that is the answer they are looking for. However, it is surprisingly inaccurate for diagnostic purposes — who knew!

The presenters at the conference told physicians that this is a serious mistake. Instead, doctors at the conference were encouraged over and over again to ask a different question which almost always yielded wildly varying answers:

“How many headache pain free days do you have each month?” This means completely pain free, with no Migraine or head pain symptoms at all.

Now we all know that pain is only one single symptom of a Migraine attack, and Migraine itself is NOT a headache. But stick with me while I explain…

The truth is that most Migraineurs who have frequent attacks tend to dismiss mildly painful days or tension type headache because they are used to experiencing Migraine attacks that are very severe in nature. They don’t mention to their doctors that they feel lousy nearly every day, assuming that the mildly painful days were not important. Sometimes they don’t mention those days because they didn’t recognize their symptoms as Migraine. Sometimes they recognize them as tension type or other headaches mixed with their Migraine attacks, and leave them out of the discussion.

This is a big mistake.

The fact is, all head pain is very important in diagnosis and may lead you toward more targeted, effective treatment, even possibly resulting in switching back again from chronic Migraine to episodic.

This is the first line in how the ICHD-II currently defines chronic Migraine :

  • Headache (tension-type and/or migraine) on 15 or more days per month for at least 3 months

This actually means that you may have clearly identifiable Migraine attacks fewer than 15 days per month and still fall into the chronic Migraine category because you aren’t experiencing enough pain free days.

This is definitely a case of patients trying to answer their doctor’s question to the best of their ability, but not really understanding what the doctor is actually needing to hear.

Now that you know what doctors actually need to hear, does your answer change? Have you been giving your doctor what you think he wants to know, or what he needs to hear?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
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