Dr Vinson raises 2 critical issues for appropriate diagnosis and treatment of migraine: the utility of the diagnostic criteria of the IHS and the appropriateness of therapy other than triptans or dihydroergotamine, the "migraine-specific" drugs.
In the Urgent Care Department studied, an adequate history to exclude migraine was documented in only 33% of charts with nonmigraine diagnoses. Of 27 patients with nonmigraine diagnoses who were later interviewed, all but 3 had episodic migraine or chronic daily headache with migraine. A previous study found that only 50% of migraineurs who seek care are accurately diagnosed.1 Thus, the misdiagnosis of headache patients by primary care physicians may reflect the fact that IHS criteria are not well known clinically, or, as noted by Dr Vinson, that they may be poorly suited for use in primary care settings.
Maizels M. Emergency Department Treatment of Migraine Headaches—Reply. Arch Intern Med. 2002;162(7):845-846. doi: