Migraine diagnosis

Although migraine is widely recognized as a disease that exacts an enormous toll on the sufferer, the direct and indirect costs associated with migraine headache impose a substantial burden on society as well. The direct costs associated with migraine diagnosis and treatment are substantial. The volume of health care services used... 

Lipton RB, Diamond S, Reed M, et al. Migraine diagnosis and treatment Results from the American Migraine Smdy II. Headache 2001 41 638-645. 

Clinical Presentation and Diagnosis of Migraine without Aura ... 

A comprehensive headache history is the most important element in establishing the diagnosis of migraine. 

Use 5-HTi agonists only where a clear diagnosis of migraine has been established. Risk of myocardial ischemia or infarction and other adverse cardiac events Because of the potential of this class of compounds to cause coronary vasospasm, do not give these agents to patients with documented ischemic or vasospastic coronary artery disease (CAD). 

Unlabeled Uses Diagnosis of pheochromocytoma, opioid withdrawal, prevention of migraine headaches, treatment of diarrhea in diabetes mellitus, menopausal flushing... 

Classical migraine with typical visual symptoms preceding unilateral headache are seldom a differential diagnosis with ischemic stroke. Increased awareness of patients of ischemic symptoms and rapid presentation to emergency rooms with immediate initiation of thrombolytic therapy may chal-... 

We found stroke MRI (FLAIR, MRA, DWI, and PI) helpful in patients with complicated migraine that presented with an aura of aphasia and hemiparesis. A negative DWI in the presence of normal MRA and PI made stroke an unlikely diagnosis and the further course of the disorder with typical migraine headache and complete resolution of the focal neurological signs within a few hours were supportive. 

In the literature, stroke mimicry - the misdiagnosis of stroke due to a non-vascular medical condition that simulates a stroke syndrome - refers to cases where the diagnosis of a stroke was made on the basis of a skilled examination but finally turned out to be wrong. Typical examples of stroke mimicry are metabolic and toxic disturbances, complicated migraine, Todd s paralysis, conversion disorders and brain tumors. 

Guidelines for the Diagnosis and Management of Migraine in Qinical Practice. Canadian Medical Association Journal 156 (May 1,1997) 1273-1287. 

Patients with migraine who use daily codeine or other opioids can be more susceptible to chronic daily headaches this is evident in opiate overuse. In a pilot questionnaire study of 32 patients who used codeine or other opioids for control of their bowel motility after colectomy, chronic daily headaches occurred in those who were misusing opioids, but only if they had pre-existing migraine (3). The study had significant limitations, including the small sample size, diagnosis by means of a mailed questionnaire, a short duration of overuse of opioids, and the fact that it was uncontrolled. 

The International Headache Society classifies headaches into one of 13 categories, ranging from migraine, tension-type, and cluster headaches, to headaches that are not classifiable. Effective headache treatment is thus guided by an accurate diagnosis of the headache type. 

A good herbalist treats people, not diseases. Ten patients diagnosed with rheumatoid arthritis would get ten different protocols based on their unique constitutions and symptom pictures. Some parts of the treatments may overlap, but Chris Smith, who is 72 years old, chronically constipated, has impaired circulation, and suffers from insomnia in addition to rheumatoid arthritis, presents a very different picture than does Angela Jones, who is 32 years old, has terrible premenstrual and menstrual problems, hyperchlorhydria (excess stomach acid), and migraine headaches as well as rheumatoid arthritis. A well-done herbal protocol will use differential diagnosis and energetics to create a specific treatment for each person. 

Kaniecki RG. Migraine and tension-type headache An assessment of challenges in diagnosis. Neurology 2002 58(suppl 6) S 15-20. 

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