Diagnosing migraines proves to be a headache

The brain's ability to refer pain to various parts of the face and head has helped promote a diagnosis of sinus headache.

By Susan J. Landers, AMNews staff. Dec. 12, 2005.

Washington -- Only about half of the millions of people who have migraine headaches are properly diagnosed as migraineurs, a rather elegant name that belies the intensity of the malady some liken to an ice pick to the head.

This misdiagnosis is shaping up to be a major public health problem, said Mark W. Green, MD, director of Columbia University's Headache Center in New York City.

The debilitating headaches affect about 20% of the U.S. population, said Dr. Green, who spoke Nov. 10 at the AMA's 24th annual Science Reporters Conference in Washington, D.C.

Whenever a patient enters a physician's office complaining of a disabling headache, the chances that the patient is a migraineur are nine out of 10, said Robert Kaniecki, MD, director of the headache center at the University of Pittsburgh, in a separate interview. "But you'll find that five are correctly diagnosed with migraine, two with sinus headaches, two with tension headaches and one with something else."

People may also walk out with a diagnosis of five different headache types. But what they all have are migraines, which are very much a brain problem, Dr. Green said.

The brain, like the heart, can refer pain to various parts of the body. The heart, of course, can refer pain to the arm, chest or jaw. But there is just one diagnosis -- heart attack -- rather than several different types of heart attacks, noted Dr. Green.

For some people with migraines, though, there is not just one answer. Their complaints of jaw pain are diagnosed as TMJ. Others who have pain in the area around the eyes are diagnosed with sinus headaches. However, the experts say most likely have migraines.