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Current Pain and Headache Reports

Erschienen in:

01.09.2019 | Secondary Headache (M Robbins, Section Editor)

Migraine as a Stroke Mimic and as a Stroke Chameleon

verfasst von: Oleg Otlivanchik, Ava L. Liberman

Erschienen in: Current Pain and Headache Reports | Ausgabe 9/2019

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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.

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Titel: Migraine as a Stroke Mimic and as a Stroke Chameleon
verfasst von: Oleg Otlivanchik
Ava L. Liberman
Publikationsdatum: 01.09.2019
Verlag: Springer US
Erschienen in: Current Pain and Headache Reports / Ausgabe 9/2019
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-019-0801-1

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