Article

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.

0 Bookmarks
 · 
117 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Migraine is a common disorder that is highly co-morbid with psychopathological conditions such as depression and anxiety. Despite the extensive research and availability of treatment, migraine remains under-recognised and undertreated. The aim of this study was to design a short and practical screening tool to identify migraine for clinical and research purposes. The structured migraine interview (SMI) based on the International Classification of Headache Disorders (ICHD) criteria was used in a clinical setting of headache sufferers and compared to clinical diagnosis by headache specialist. In addition to the validating characteristics of the interview different methods of administration were also tested. The SMI has high sensitivity (0.87) and modest specificity (0.58) when compared to headache specialist's clinical diagnosis. Our study demonstrated that a structured interview based on the ICHD criteria is a useful and valid tool to identify migraine in research settings and to a limited extent in clinical settings, and could be used in studies on large samples where clinical interviews are less practical.
    BMC Neurology 01/2010; 10:7. · 2.56 Impact Factor
  • Source
  • Source
    [Show abstract] [Hide abstract]
    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.
    The Journal of the Association of Physicians of India 04/2010; 58 Suppl:10-3.

Full-text (2 Sources)

Download
54 Downloads
Available from
Jun 2, 2014