Maizels M
Department of Family Practice, Kaiser Permanente, 5601 De Soto Ave, Woodland Hills, CA 91365-4084, USA.
Arch Intern Med. 2001 Sep 10;161(16):1969-73. doi: 10.1001/archinte.161.16.1969.
Despite advances in treatment, patients with migraine have been underdiagnosed and undertreated.
Documentation of visits by patients with headache to an urgent care department staffed by primary care physicians was reviewed. Patients were also sent a brief headache screen, and those who replied were interviewed by telephone. "Repeaters" (patients who made 3 or more visits in 6 months) were excluded from chart review.
Over 6 months, 518 patients made 1004 visits to the emergency department for primary headache complaints: 464 patients (90%) made 1 or 2 visits (total visits, 502). A review of 174 charts documenting a diagnosis of migraine found that (1) the need for prophylaxis was determined in only 40 (31%) of the patients who were not already undergoing prophylaxis and (2) treatment in the emergency department was migraine specific in 46 patients (26%) or otherwise appropriate in 45 (25%). A review of 90 charts documenting nonmigraine diagnoses found that 30 patients (33%) had adequate history documented to exclude migraine as the diagnosis. Eighty-six patients (17%) were interviewed. An emergency department diagnosis of migraine (n = 59) corresponded to a final diagnosis of migraine with (n = 21) or without (n = 18) medication overuse or chronic daily headache and/or transformed migraine with (n = 18) or without (n = 2) medication overuse. Discharge diagnoses that were not migraine (n = 27) had final diagnoses of migraine with (n = 9) or without (n = 9) medication overuse or chronic daily headache/transformed migraine with (n = 7) or without (n = 2) medication overuse.
In this emergency department population, many patients with migraine, chronic daily headache, or medication overuse are not accurately diagnosed. The need for prophylaxis is not usually assessed. Treatment is migraine specific in the minority of patients. Tension-type headache is rarely an accurate diagnosis in this emergency department population.
尽管治疗方面有所进展，但偏头痛患者仍存在诊断不足和治疗不充分的情况。
回顾了由初级保健医生坐诊的紧急护理部门中头痛患者的就诊记录。还向患者发送了一份简短的头痛筛查问卷，对回复者进行了电话访谈。“复诊患者”（6个月内就诊3次或更多次的患者）被排除在病历审查之外。
在6个月的时间里，518名患者因原发性头痛主诉到急诊科就诊1004次：464名患者（90%）就诊1或2次（总就诊次数为502次）。对174份诊断为偏头痛的病历进行审查发现：（1）在尚未接受预防性治疗的患者中，只有40名（31%）患者的预防性治疗需求得到了确定；（2）在急诊科接受的治疗中，46名患者（26%）的治疗针对偏头痛，45名患者（25%）的治疗在其他方面是合适的。对90份诊断为非偏头痛的病历进行审查发现，30名患者（33%）有足够的病史记录可排除偏头痛诊断。86名患者（17%）接受了访谈。急诊科诊断为偏头痛（n = 59）的患者最终诊断为伴有（n = 21）或不伴有（n = 18）药物滥用或慢性每日头痛和/或转化型偏头痛伴有（n = 18）或不伴有（n = 2）药物滥用的偏头痛。出院诊断不是偏头痛（n = 27）的患者最终诊断为伴有（n = 9）或不伴有（n = 9）药物滥用或慢性每日头痛/转化型偏头痛伴有（n = 7）或不伴有（n = 2）药物滥用的偏头痛。
在这个急诊科人群中，许多患有偏头痛（migraine）、慢性每日头痛或药物滥用的患者没有得到准确诊断。预防性治疗的需求通常未得到评估。少数患者的治疗针对偏头痛。在这个急诊科人群中，紧张型头痛很少是准确的诊断。
