Migraine Knowledge Gaps Lead to Misdiagnoses and Delayed Treatment

A physician speaking to a patient
A physician speaking to a patient
A knowledge gap is explored by investigators as the cause of delayed treatment in migraine.

Throughout Mexico and several European and South American countries, a high percentage of patients and physicians possess inadequate education regarding migraine, resulting in frequent misdiagnoses and poor management, according to study results published in the European Journal of Neurology.

The research was conducted at 12 headache centers across 7 countries, including Brazil, Italy, Moldova, Mexico, Argentina, Chile, and Uruguay. Centers enrolled up to 100 patients who were referred for a first visit and were diagnosed with migraine. Patients were included if they were diagnosed with episodic migraine with and/or without aura and/or chronic migraine. Patients were asked 9 questions by a neurologist via a structured clinical questionnaire. These questions were designed to ascertain patients’ knowledge and perceptions about their diagnosis, the cause of their migraine, previous diagnoses, investigations, and treatments prescribed by their clinicians.

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A total of 1161 patients with migraine completed the multicenter study. Only 28% of patients were aware that they had migraine, whereas 64% of the overall cohort termed their migraine “a headache.” Cervical pain, tension headache, and sinusitis were the most common incorrect terms patients used to label their migraines. Approximately 28% of patients were correctly diagnosed with migraine after a visit with their general practitioner. Only 35% of specialists, including neurologists and/or headache specialists (51%), provided patients with a correct diagnosis of migraine.

Approximately half of patients had undergone either radiography, computed tomography, and/or magnetic resonance imaging of the cervical spine prior to entering the study. In addition, 76% of patients underwent cervical spine and/or brain imaging during a migraine consultation. Symptomatic migraine-specific medications were prescribed in only 28% of patients, whereas ≥1 migraine preventive medication was prescribed in 29% of patients.

According to multivariate analyses, an increased likelihood of being aware of a migraine diagnosis correlated with a high education level (odds ratio [OR], 1.97; 95% CI, 1.43-2.78; P <.001), number of family members with migraine (OR, 1.17; 95% CI, 1.04-1.31; P =.005), throbbing pain (OR, 2.02; 95% CI, 1.23-3.31; P =.005), lateralization of pain (OR, 1.36; 95% CI, 1.01-1.83; P =.043), and vomiting (OR, 1.43; 95% CI, 1.06-1.93; P =.018). Having shorter duration of attacks independently decreased the likelihood of being aware of a migraine diagnosis (OR, 0.98; 95% CI, 0.97-0.99; P =.001).

A study limitation was the inclusion of only patients who were referred to tertiary headache care centers, which may limit the generalizability of the findings. In addition, the use of a self-reported, nonvalidated questionnaire may have led to recall bias and overestimation of previous physicians’ misdiagnoses.

The researchers wrote that “poor awareness of migraine amongst sufferers and those doctors they sought consultation from led to unnecessary risk exposure and costs, and prevented or delayed access to appropriate treatments.”


Viana M, Khaliq F, Zecca C, et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort [published online October 1, 2019]. Eur J Neurol. doi:10.1111/ene.14098