Master these 3 forms, acute migraine diagnosis is no longer "headache"

Introduction Migraine is a disease that can seriously affect the quality of life of patients, and can also increase the risk of stroke, depression and other painful diseases
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At present, the diagnostic criteria for migraine have been relatively complete, and some memory skills can also help to make an accurate diagnosis
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This article will introduce the main points of the diagnosis of migraine for everyone to learn
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Main features of migraine diagnosis Typical migraine attack features include photophobia, phonophobia, nausea and other symptoms, but before a migraine attack, up to 30% of patients will have localized neurological symptoms, so-called migraine "Omen"
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In addition, symptoms that may persist before and after a headache include yawning, mood changes, sensitivity to light, neck pain, and fatigue
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Table 1 lists the diagnostic criteria for migraine with aura and migraine without aura
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Based on some characteristics of migraine, some scholars have proposed the use of the word "POUND" to assist in diagnosis, using the five most important characteristics of migraine as a prompt
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The higher the number of characteristics that a patient meets, the higher the likelihood of a diagnosis of migraine
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➤ P (Pulsatile)—the headache is pulsatile in nature; ➤ O (One-day)—the headache lasts about 1 day, specifically, 4 to 72 if untreated or unsuccessfully treated ➤ U (Unilateral)—unilateral headache; ➤ N (Nausea)—with nausea or vomiting; ➤ D (Disabling)—headache disabling
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Differential Diagnosis Points for Migraine Migraine is by no means the only disorder that can present with headache, but most disorders in the differential diagnosis can be determined by history and physical examination
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Auxiliary workup is required only when a patient's headache is suspected to be secondary, or when the etiology of comorbidities is identified
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Table 2 lists common differentiating disorders and points of differentiation in patients with migraine
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In addition, if a patient develops the warning signs listed in Table 3, further evaluation is indicated
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Regarding the warning signs of headaches, some scholars also proposed a mnemonic - "SNOOP" for your reference: ➤ S (Systemic) - accompanied by symptoms and signs of systemic diseases, including fever, chills, myalgia, and weight loss ➤ N (Neurologic)—with focal neurological symptoms and signs; ➤ O (Older)—older (new onset headache over 50 years); ➤ O (Onset)—sudden onset (thunderclap headache) ; ➤ P1 (Papilledema) - papilledema; ➤ P2 (Positional) - headache related to posture; ➤ P3 (Precipitated) - triggered by Valsalva maneuver or exertion; ➤ P4 (Progressive) - progressive headache or Changes in the nature of the headache
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What manifestations in patients with migraine diagnostic questions suggest that the cause of their headache is not serious? The more similar the nature of this patient's headache to previous headaches, the more likely it is that the cause of the headache is not serious
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If the timing of a patient's headache is predictable, such as when it occurs near the menstrual period or ovulation, it is also suggestive that it is not serious
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Other patient characteristics that suggest less severe headaches include hunger or anger, alcohol intake, lack of sleep, family history of headaches, and motion sickness
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Does every headache patient need neuroimaging to rule out a diagnosis? It mainly depends on the clinical symptoms of the patient
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Further investigation is warranted if there are signs that the migraine is caused by another disorder, or if the patient has a marked change in aura symptoms, or if the migraine recurs with atypical symptoms
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However, if the patient has typical aura and fits the typical age characteristics of the patient population, then imaging studies are not necessary
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In addition, if migraine attacks recur in elderly patients, such recurrences may also be caused by vascular disease or tumors, in which case neuroimaging should be performed to rule out the underlying disease
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Although a growing body of research shows that certain lesions in the brain, such as high signal intensity in the white matter of the brain, are more common in migraine sufferers
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However, it remains unclear what these lesions mean to patients and what consequences they can have, so imaging tests to identify these brain lesions are not necessary
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What tools are available to help doctors diagnose migraines? The more information a doctor has on a patient's first visit, the more accurate the diagnosis will be
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For example, it would be more helpful to support the diagnosis if the patient brought along his/her headache diary, or a questionnaire with detailed migraine-related information
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Second, identifying a patient's triggers for migraine is also important for diagnosis
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That's why doctors recommend that patients keep a headache diary
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A complete headache diary can include the characteristics of the patient's headache attack, duration of symptoms, triggering and relieving factors, etc.
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References: [1] Caren G.
Solomon.
Migraine.
N Engl J Med 377;6.
[2] Mayans L, Walling A.
Acute Migraine Headache: Treatment Strategies[J].
American family physician, 2018, 97(4) .
[3] Kurth T, Silberstein S, Buse D, et al.
Epidemiology, Assessment, and Diagnosis of Migraine[J].
The Medical Roundtable General Medicine Edition, 2018.