Migraine misdiagnosis: the most common mistakes

Migraine misdiagnosis is common. Many people are told for years that they have an ordinary headache, tension-type headache or stress, when in fact they have migraine. Migraine is a brain condition with clear official criteria, and recognising it is the first step to the right treatment.

Perhaps you think you just get headaches. Or you have been told it is tension-type headache, or even cluster headache. But in reality it is migraine, and that is something quite different.

Why is migraine so often misdiagnosed?

Migraine is a brain condition, not an ordinary headache. Yet it often goes unrecognised. Symptoms vary a great deal from person to person, and not every clinician knows the details of migraine well. That leads to mistakes in diagnosis.

Some people have blurred vision or tingling before the headache starts, others do not. Some vomit, others do not. As a result, people are often misunderstood or not taken seriously.

What are the most common mistakes in diagnosing migraine?

1. Confusing it with tension-type headache. Migraine is often one-sided, throbbing and worse with movement. Tension-type headache is usually on both sides and pressing. Even so, the two are often mixed up.
2. Looking only at the headache. Migraine is much more than headache. Nausea, sensitivity to light and sound, and aura are all part of it.
3. Putting it down to stress. Stress can be a trigger, but migraine is not a psychological complaint. It is a neurological condition with a hereditary basis.

What are the official criteria for migraine?

Migraine is diagnosed using the criteria of the International Headache Society (IHS). There is no blood test or scan for migraine: the diagnosis is based on your symptoms.

Migraine without aura

1. At least 5 attacks that meet criteria 2 to 4
2. Attacks last 4 to 72 hours (untreated or unsuccessfully treated)
3. At least 2 of the following:
   • one-sided headache
   • pulsating or throbbing quality
   • moderate to severe pain (gets in the way of daily activities)
   • made worse by routine physical activity, such as climbing stairs
4. During the attack, at least 1 of:
   • nausea and/or vomiting
   • photophobia and phonophobia (sensitivity to light and sound)
5. The headache is not better explained by another condition

Migraine with aura

1. At least 2 attacks
2. One or more fully reversible aura symptoms: visual, sensory, speech or language, motor, brainstem or retinal
3. At least 3 of the following 6:
   • at least one aura symptom spreads gradually over 5 minutes or more
   • two or more aura symptoms occur one after the other
   • each aura symptom lasts 5 to 60 minutes
   • at least one aura symptom is on one side only
   • at least one aura symptom is positive (for example flickering lights or pins and needles)
   • the aura comes with a headache, or is followed by one within 60 minutes
4. Not better explained by another condition

Chronic migraine

1. Headache on 15 or more days a month for more than 3 months, in someone with migraine
2. On at least 8 of those days a month, the headache has migraine features
3. Not better explained by another condition

What can you do if you think you have been misdiagnosed?

Keep a headache diary. Note when you have symptoms and what you feel. Ask your GP or a migraine specialist directly whether you could have migraine, and be critical if you are given a vague label such as tension-type headache without a clear explanation.

Are the criteria the final word?

The international criteria (ICHD-3) are important, but they are not a rulebook to be applied blindly. They help to recognise migraine, but they should never be a reason to dismiss your symptoms. Migraine is not just a headache, and with the right diagnosis, good treatment is possible.

Get a diagnosis from a migraine specialist

At The Migraine Clinic you can book a video consultation with a migraine specialist yourself, without a referral. Take the migraine test to see whether your symptoms fit migraine, read what migraine is, or find out how to start.