Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, 10467, USA.
Curr Pain Headache Rep. 2019 Jul 29;23(9):63. doi: 10.1007/s11916-019-0801-1.
This review details the frequency of and ways in which migraine can be both an ischemic stroke/transient ischemic attack mimic (false positive) and chameleon (false negative). We additionally seek to clarify the complex relationships between migraine and cerebrovascular diseases with regard to diagnostic error.
Nearly 2% of all patients evaluated emergently for possible stroke have an ultimate diagnosis of migraine; approximately 18% of all stroke mimic patients treated with intravenous thrombolysis have a final diagnosis of migraine. Though the treatment of a patient with migraine with thrombolytics confers a low risk of complication, symptomatic intracerebral hemorrhage may occur. Three clinical prediction scores with high sensitivity and specificity exist that can aid in the diagnosis of acute cerebral ischemia. Differentiating between migraine aura and transient ischemic attacks remains challenging. On the other hand, migraine is a common incorrect diagnosis initially given to patients with stroke. Among patients discharged from an emergency visit to home with a diagnosis of a non-specific headache disorder, 0.5% were misdiagnosed. Further development of tools to quantify and understand sources of stroke misdiagnosis among patients who present with headache is warranted. Both failure to identify cerebral ischemia among patients with headache and overdiagnosis of ischemia can lead to patient harms. While some tools exist to help with acute diagnostic decision-making, additional strategies to improve diagnostic safety among patients with migraine and/or cerebral ischemia are needed.
本文详细介绍了偏头痛既可以作为缺血性卒中和短暂性脑缺血发作的模拟疾病（假阳性），也可以作为伪装疾病（假阴性）的发生频率和方式。此外，我们还试图阐明偏头痛与脑血管疾病之间在诊断错误方面的复杂关系。
近 2%的所有紧急评估可能为中风的患者最终诊断为偏头痛；接受静脉溶栓治疗的所有卒中模拟患者中，约有 18%最终诊断为偏头痛。虽然用溶栓药物治疗偏头痛患者的并发症风险较低，但可能会发生症状性颅内出血。有三个具有高灵敏度和特异性的临床预测评分可以帮助诊断急性脑缺血。偏头痛先兆与短暂性脑缺血发作之间的鉴别仍然具有挑战性。另一方面，偏头痛是最初误诊为中风的常见疾病。在因非特异性头痛疾病出院回家的急诊患者中，有 0.5%被误诊。进一步开发工具来量化和理解以头痛就诊的患者中卒中误诊的来源是必要的。在有头痛的患者中未能识别出脑缺血以及过度诊断缺血都可能导致患者伤害。虽然存在一些帮助进行急性诊断决策的工具，但仍需要针对偏头痛和/或脑缺血患者的额外策略来提高诊断安全性。
