Factors associated with delayed diagnosis of migraine: A hospital-based cross-sectional study

Migraine is common debilitating disorders, affecting 10 to 20% of the world's population. However, proper diagnosis is delayed due to many factors.

To determine various factors associated with delayed diagnosis of migraine.

Hospital-based cross-sectional study.

Patients attending Neurology OPD of AIIMS Bhopal and satisfying diagnostic criteria of the International Headache Society (ICHD-3β) for migraine were selected for study. MIDAS, MINI, and ROME-III were used. First diagnosis was considered as "Appropriate" if patients were previously diagnosed as "migraine" or getting treatment for it; otherwise labeled as "Inappropriate."

Associations were tested by Chi-square, t-test, or Mann-Whitney test. Logistic regression analysis was used for identifying independent factors associated with inappropriate diagnosis.

Hundred patients (female = 77) of migraine were included. Mean age (SD) was 32.42 (10.74). Diagnosis was "inappropriate" in 65 patients. Number of inappropriate diagnosis/appropriate diagnosis was 10/40 (25%) by neurologists; 35/39 (89.3%) by physicians; 18/18 (100%) by ophthalmologists. Factors associated with "Inappropriate Diagnosis" were "Neurologist vs Other Doctors" {10 (25%) vs 55 (91.7%), P < 0.001}; throbbing vs other types of headache {51 (60.7%) vs 14 (87%), P = 0.047}; and temporal vs other sites {9 (42.9%) vs 56 (70.9%), P = 0.017}. Patients with "Inappropriate Diagnosis" had to expend more money {7000 (4,500; 12,500) vs 4000 (1000, 6000), P < 0.01; median (interquartile range) all in INR}. Other clinical parameters including vertigo, cervical pain, anxiety, depression, and functional gastrointestinal symptoms were not associated with delayed diagnosis.

Delayed diagnosis and misdiagnosis is very frequent in migraine, leading to financial burden to patients. Management of common disorders like migraine should be addressed in undergraduate medical teaching curriculum.