Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort

BACKGROUND: Although migraine is the second most disabling condition worldwide, there is poor awareness of it. OBJECTIVES: To assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS: Multicenter study conducted in 12 headache centers in seven countries. Each center recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffer from, its cause, previous diagnoses, investigations and treatments. RESULTS: 1161 patients completed the study. Twenty eight percent of participants were aware they suffer from migraine. Sixty-four percent called their migraine "headache", less commonly they used terms such as "cervical pain" (4%), tension headache (3%) and sinusitis (1%). Eight percent of general practisers and 35% of specialists (of which 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, CT and/or MRI of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty eight percent of patients had received symptomatic migraine specific medications and 29% at least one migraine preventative medication. CONCLUSIONS: Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of promotion of migraine awareness to reduce its burden, limit direct and indirect costs, and the risk of exposure to useless investigations.