The use of questions to determine the presence of photophobia and phonophobia during migraine.

Baylor College of Medicine - Neurology, Houston, TX, USA.
Headache The Journal of Head and Face Pain (Impact Factor: 2.94). 04/2008; 48(3):395-7. DOI: 10.1111/j.1526-4610.2007.00920.x
Source: PubMed

ABSTRACT To investigate whether the use of more detailed close-ended questions as part of the routine headache history is helpful when patients initially deny that they are sensitive to light and noise during migraine headaches.
According to the International Headache Society 2004 criteria, the diagnosis of migraine requires the presence of at least one of the following during a headache: (1) nausea and/or vomiting, (2) photophobia and phonophobia. Evans anecdotally noted that many patients answer the question, "does light or noise bother you during a headache," with a "no" when the answer is really "yes" if they are asked more detailed close-ended questions.
Consecutive patients fulfilling International Headache Society 2004 criteria for migraine or probable migraine presenting to a headache clinic and a neurology clinic were asked the following questions: "does light bother you during a headache?" If "no," they were then asked, "during a headache, would you prefer to be in bright sunlight or in a dark room?"does noise bother you during a headache?" If "no," they were then asked, "during a headache, would you prefer to be in a room with loud music or in a quiet room?"
Eighty-five consecutive patients with migraine or probable migraine were questioned, 71 females (83.5%) and 14 males (16.5%). There was denial of light and sound sensitivity in 24% of patients with routine questioning and then awareness of sensitivity in 93% with the further questioning. A total of 7.1% of the patients were diagnosed with probable migraine. However, if the additional questions were not asked, 8% more of the patients with definite migraine would have been incorrectly diagnosed as probable migraine.
When patients initially deny light and noise sensitivity during migraine headaches, additional questions should be asked to ensure that their answer is accurate. Not asking the additional questions may result in the over-diagnosis of probable migraine.

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    ABSTRACT: Photophobia is an important criterion for the diagnosis of migraine. However, several Asian epidemiological surveys about migraine have shown lesser prevalence of photophobia than that of Western studies. This discrepancy is probably caused by underestimation of photophobia due to inappropriate questioning of patients by physicians. To investigate this issue, we developed a questionnaire about photophobia and evaluated its usefulness in 103 patients with migraine. In phase 1 of the study, we found good repeatability of the questionnaire with a 0.826 kappa coefficient. In phase 2, the prevalence of photophobia from interviews and that from the questionnaire were compared. The prevalence of interview-documented photophobia was 51.5% and of questionnaire-documented photophobia 82.5% (P < 0.001). In phase 3, we attempted to make a short-form questionnaire with the same detection power of the questionnaire study. Two short-form questionnaires were identified as a useful method for detecting photophobia. The prevalence of photophobia could be underreported via interview, especially in Asian migraineurs. Using this questionnaire to test for photophobia, the diagnostic rate of photophobia and migraine could be improved.
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    ABSTRACT: Although the understanding of the pathophysiology and the pharmacology of migraine has exploded there are still many pitfalls that may occur in the clinical assessment and management of migraine. This may prevent the patient from receiving optimal treatment. A diagnosis of migraine may be missed in the presence of other headache types that occur more frequently than migraine. Also, migraine may be misdiagnosed when treating physicians inappropriately interpret specific symptoms and co-morbid conditions as indicators of the presence of a non-migraine headache type such as sinus headache or tension headache. Migraine and tension-type headache share common triggers and this also contributes to the difficulty in their differential diagnosis. The non-availability of any diagnostic laboratory investigation only makes this job further difficult.
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