The study by Maizels1 on the management of emergency department patients with benign headache observed that adequate histories and physical examinations are inconsistently performed. For this corrective I am grateful. Two assertions of this study, however, merit further discussion.
By using the strict diagnostic criteria for migraine headache devised by the International Headache Society (IHS), Maizels calculates a high incidence of misdiagnosis. Because many features of the criteria were selected arbitrarily without scientific validation,2 simpler criteria for migraine have been proposed for use in clinical practice.3 One wonders how much more accurate these diagnosticians would appear if they were allowed to diagnose a migraine without aura if it was the patient's third (not fifth) episode or if it lasted 84 (not 72) hours.
Vinson DR. Emergency Department Treatment of Migraine Headaches. Arch Intern Med. 2002;162(7):845-846. doi: