Neurology Unit, ASL Alessandria, Novi Ligure, Italy.
Unit of Neurology, Neuromotor Department, Arcispedale SMN - IRCCS, Reggio Emilia, Italy.
Headache. 2020 Jan;60(1):81-89. doi: 10.1111/head.13679. Epub 2019 Sep 26.
The primary aim of this study was to assess the degree of awareness migraine patients had of their condition. The secondary aims were to evaluate the frequency of an incorrect diagnosis of "cervical arthrosis" in patients unaware of having migraine and to compare the clinical features, diagnostic investigation, and treatment strategies between the 2 subgroups of migraineurs, that is, those with and without the incorrect diagnosis of "cervical arthrosis."
Patients, between 18 and 65 years, were consecutively referred to 5 Headache Centers in 2 Italian regions for a first visit. They fulfilled the diagnostic criteria for migraine (with/without aura, episodic/chronic) and were enrolled in this cross-sectional study. Each patient underwent a specific cranial/cervical musculoskeletal clinical examination.
A total of 117/250 subjects (46.8%) were unaware that they suffered from migraine. In these unaware subjects, the most frequently reported diagnosis was "cervical arthrosis" in 34/117 (29.1%), followed by tension-type headache in 23/117 (19%). The cervical region was the most common site of pain onset in the so-called "cervical arthrosis" group (52.9%, P < .0001), where also more pericranial (58.8%; P = .041) and neck (70.6%; P = .009) muscle tenderness, restricted range of cervical vertical (47.1%; P < .001), and lateral (29.4%; P = .040) movements were reported. More "cervical arthrosis patients" had been referred to an Emergency Department (88.2%; P = .011) and had undergone more cervical spine radiography (23.5%; P = .003) and magnetic resonance imaging (20.6%; P = .044). While they had used fewer triptans (11.8%; P = .007) and received less pharmacological prophylaxis (2.9%; P = .004).
In our sample, there were high misdiagnosis rates for migraine sufferers in Italy. The most common misdiagnosis, that is, "cervical arthrosis," led to misuse of healthcare facilities and had a negative impact on the migraine treatment.
本研究的主要目的是评估偏头痛患者对自身病情的认知程度。次要目的是评估在那些对偏头痛不自知的患者中，错误诊断为“颈椎关节病”的频率，并比较存在和不存在错误诊断“颈椎关节病”的偏头痛患者的临床特征、诊断调查和治疗策略。
在意大利的两个地区，5 个头痛中心连续为 250 名 18-65 岁的患者进行首次就诊。这些患者符合偏头痛的诊断标准（有/无先兆，发作性/慢性），并被纳入本横断面研究。每位患者都接受了特定的颅颈肌肉骨骼临床检查。
250 名患者中有 117 名（46.8%）不知道自己患有偏头痛。在这些不自知的患者中，最常报告的诊断是“颈椎关节病”，占 34/117（29.1%），其次是紧张型头痛，占 23/117（19%）。在所谓的“颈椎关节病”组中，颈部是疼痛起始最常见的部位（52.9%，P<.0001），在该组中，更多的颅周（58.8%，P=.041）和颈部（70.6%，P=.009）肌肉触痛、颈椎垂直运动受限（47.1%，P<.001）和侧向运动受限（29.4%，P=.040）也更为常见。更多的“颈椎关节病患者”曾被转诊至急诊（88.2%，P=.011），并进行了更多的颈椎 X 光检查（23.5%，P=.003）和磁共振成像（20.6%，P=.044）。同时，他们使用的曲坦类药物更少（11.8%，P=.007），接受的药物预防治疗也更少（2.9%，P=.004）。
在我们的样本中，意大利偏头痛患者存在较高的误诊率。最常见的误诊诊断，即“颈椎关节病”，导致了医疗资源的滥用，并对偏头痛的治疗产生了负面影响。
