Migraine as a Stroke Mimic and as a Stroke Chameleon

Oleg Otlivanchik, Ava Leigh Liberman

Research output: Contribution to journalReview article

Abstract

Purpose of Review: This review details the frequency of and ways in which migraine can be both an ischemic stroke/transient ischemic attack mimic (false positive) and chameleon (false negative). We additionally seek to clarify the complex relationships between migraine and cerebrovascular diseases with regard to diagnostic error. Recent Findings: Nearly 2% of all patients evaluated emergently for possible stroke have an ultimate diagnosis of migraine; approximately 18% of all stroke mimic patients treated with intravenous thrombolysis have a final diagnosis of migraine. Though the treatment of a patient with migraine with thrombolytics confers a low risk of complication, symptomatic intracerebral hemorrhage may occur. Three clinical prediction scores with high sensitivity and specificity exist that can aid in the diagnosis of acute cerebral ischemia. Differentiating between migraine aura and transient ischemic attacks remains challenging. On the other hand, migraine is a common incorrect diagnosis initially given to patients with stroke. Among patients discharged from an emergency visit to home with a diagnosis of a non-specific headache disorder, 0.5% were misdiagnosed. Further development of tools to quantify and understand sources of stroke misdiagnosis among patients who present with headache is warranted. Summary: Both failure to identify cerebral ischemia among patients with headache and overdiagnosis of ischemia can lead to patient harms. While some tools exist to help with acute diagnostic decision-making, additional strategies to improve diagnostic safety among patients with migraine and/or cerebral ischemia are needed.

Original languageEnglish (US)
Article number63
JournalCurrent Pain and Headache Reports
Volume23
Issue number9
DOIs
StatePublished - Sep 1 2019

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Lizards
Migraine Disorders
Stroke
Diagnostic Errors
Brain Ischemia
Transient Ischemic Attack
Headache
Patient Harm
Cerebrovascular Disorders
Headache Disorders
House Calls
tebufenozide
Cerebral Hemorrhage
Patient Safety
Epilepsy
Decision Making
Emergencies
Ischemia
Sensitivity and Specificity

Keywords

  • Acute ischemic stroke
  • Diagnostic error
  • Migraine
  • Migraine with aura
  • Stroke mimic

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Migraine as a Stroke Mimic and as a Stroke Chameleon. / Otlivanchik, Oleg; Liberman, Ava Leigh.

In: Current Pain and Headache Reports, Vol. 23, No. 9, 63, 01.09.2019.

Research output: Contribution to journalReview article

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