Migraine’s – Often Misdiagnosed

I am not sure but I think 80% of everyone out there has migraine’s. Often, they are told this by their primary doctor and the patient takes this diagnosis to heart. As a pain management doctor I get very annoyed when people are given a diagnosis without a proper work up. It would be as if I had a patient with a lump and told them that they had cancer. Obviously, more information is needed to make a correct diagnosis. There are numerous types of headaches; some common and some not, but not everyone has migraines. Believe it or not, true migraines are very specific types of headaches. Migraines are what are know as vascular headaches. This implies that the headache is from a vasoconstrictor or tightening of the blood vessels in the brain. The exact cause for this vasoconstriction is unknown but it may be due to elevated neural activity in the cortex of the brain. Migraines are much more common in women then men and often there are hormonal issues associated with the migraines. Migraines are usually unilateral or involves one side of the head. There is usually a prodrome which is a syndrome of symptoms that occurs before the headache ever occurs. The prodrome includes symptoms such as mood changes, tiredness and vague abdominal pain. Many people also have an aura, which involves symptoms immediately before the headache such as visual changes, olfactory changes such as unusual smells, even numbness or vertigo. Also, migraine generally occur infrequently, like once a month and definitely ot every day. The important issue that I am trying to state is that most people who come into my office an have been told that they have migraines have something else. Most people I see have chronic headaches that are bilateral in nature and often occur frequently. In most of these people, their headaches are often related to the neck. The headaches literally are coming from the neck region. These types of headaches are due to the joints, muscles, discs or even the nerves of the neck resulting in spasms in the neck region that affect the nerves that run up the back of the head. These headaches are often bilateral and often chronic and regular. They are often everyday headaches and unless you understand the cause you’ll never fix them. These neck related headaches can be called tension headaches, cervicogenic headaches, or occipital neuralgia. These headaches can be just as severe as migraines and people should not think that just because their headache is severe that it must be a migraine. If your symptoms fit into the non-migraine type of headache then the first thing is to accept that your headache isn’t a migraine and the second is to try and figure out why you are having these headaches. I am not going to get into the work up of cervicogenic headaches but an appropriate evaluation can often lead to a possible treatment. Often an MRI is needed but sometimes the only finding is reduction in the cervical curvature. Nonetheless, the treatment for migraines is different than cervicogenic headaches. Migraines have specific medications that treat them while cervicogenic headaches have treatments such as injections and medications to reduce the muscular spasms. Also, if there are obvious abnormalities on the MRI then those could be addressed to resolve the headaches. The key is to realize what your true diagnosis is. Once you have that then true treatment can occur.

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