How do you know if you have chronic migraine or some other type of headache disorder?
It can be challenging to determine whether a headache disorder is chronic migraine or another type of the many headache disorders that exist. An accurate diagnosis is critical to proper management of the disease, so ensuring the diagnosis is correct initially and that it is periodically re-evaluated is important.
“There are over 15 pages of migraine differentials alone, and over 300 differential diagnoses for headache. I would say that the best thing to do is to make sure it's chronic migraine, or chronic daily headache. Therefore, you have to rule out things like chronic tension-type headache, which some people have questioned whether it even exists. I know somebody else will talk about that, but the important point is, you want to make sure they don't have hemicrania continua, new daily persistent headache, chronic tension headache, or chronic migraine. These can be very difficult to sort out. For instance, I had a patient the other day, and I said, ‘Let's go back and start with the history again.’ The chart was getting rather sick. She said, ‘I want to go back and ask how this began.’ And she said, ‘Well it began one afternoon.’ So I explored it a bit further: It began at 2:03 p.m. October the 3rd, 10 years ago. I said, ‘Wait a minute. Did I ask you that?’ She said, ‘Yes you did.’ ‘Did you tell me the answer?’ She said, ‘No, I didn't think it was important.’ Well now she met the criteria for new daily persistent headache. Now new daily persistent headache, as you know, and all you people listening know, can look a lot like migraine. Can look a lot like chronic daily headache. Can look a lot like everything. As a result, by making that diagnosis, there are two phenotypes. One is a self-relieving one that disappears over time. The other one is one which is almost impossible to treat. If you suddenly are 10 years into treating a patient and find out the diagnosis was wrong, was another form of chronic headache, you've got a problem. Therefore, the diagnosis leads to the management.
“The trouble with modern medicine is diagnose and adios. You have migraine, goodbye. When the new triptans came out it was diagnose, dose, and adios. You got a migraine, take a triptan, goodbye. The real problem is management, and management over time is simply
treatment; management includes making sure the diagnosis is always correct. Every time you see a doctor, every year you see the doctor that you know the best, familiarity can be good, it also can be very bad. Make sure that you ask, ‘You think I have migraine? What
type of migraine? is it changing into something else? Are there other things that are affecting the diagnosis? Do I need more testing and investigation?’ "
Allan Purdy, MD
Professor of Neurology
Dalhousie University, Canada
Dr. Allan Purdy is a neurologist and a professor at Dalhousie University in Nova Scotia, Canada. Dr. Purdy is currently President of the American Headache Society. He has also served as president of the Canadian Headache Society and on the Board of Directors for the International Headache Society.
Dr. Purdy is regarded as one of the most gifted teachers in the field, developing educational programs for physicians around the world who care for patients with headache diseases. In addition to his research and education work, Dr. Purdy continues to see headache patients in his Canadian clinic on a part-time basis.