The role of instrumental examinations in delayed migraine diagnosis

Patients affected by migraine without aura very often consult different specialists who, misunderstanding the correct diagnosis, submit them to different instrumental examinations. The objective of the study was to assess if each instrumental examination was really useful for a faster migraine definition, or on the contrary, it increased the time delay for a correct diagnosis. We enrolled 300 consecutive patients referring to our Headache Center with a first diagnosis of migraine without aura and submitted them to a face-to-face interview about time from disease's onset to a correct diagnosis. In each patient, the first instrumental examination performed to specifically investigate migraine-related symptoms was defined. Brain MRI, brain CT, sinus CT, sinus X-rays, cervical spine X-rays and EEG were the most often performed examinations. All the exams, with the exception of brain CT, determined a significant increase of time delay in migraine diagnosis (p < 0.05). Brain CT was significantly associated with a higher probability to obtain a correct diagnosis in less than 1 year. Migraine without aura patients are usually addressed to perform radiological and other instrumental examinations. This attitude may increase the risk of time delay to obtain a correct diagnosis. The performance of a careful clinical history evaluation and neurological examination, with the addition of a brain CT when appropriate, is the best approach for a rapid and correct diagnosis of migraine without aura.