Diagnostic tests and headache misdiagnoses in individuals with resistant and refractory migraine - data from the REFINE study.

Abstract

BackgroundIndividuals with difficult-to-treat migraine, including resistant migraine (ResM) and refractory migraine (RefM), might experience treatment delays, undergo unnecessary diagnostic tests and receive misdiagnoses, which might influence treatment outcomes. For this reason, we hypothesized that individuals with ResM and RefM might report more diagnostic tests and misdiagnoses in their medical history compared with those with non-resistant/non-refractory migraine (NRNRM).MethodsThis analysis used baseline, cross-sectional data from the REFINE study, a multicenter, prospective observational study conducted in 15 European tertiary headache centers. Adults with episodic or chronic migraine were classified into RefM, ResM, or NRNRM groups. Baseline data were analyzed to assess the frequency of previous diagnostic tests and misdiagnoses.ResultsOverall, 689 participants were included with a median age of 46 years (interquartile range 36-53); 570 participants (82.7%) were female; 355 (51.5%) had NRNRM, 261 (37.9%) ResM, and 73 (10.9%) RefM. Referring to diagnostic tests, 335 participants (48.7%) had one and 237 (34.4%) multiple brain magnetic resonance imaging scans. ResM and RefM participants underwent more diagnostic tests than NRNRM. Overall, 193 participants (28.0%) had at least one prior headache misdiagnosis, most commonly cervical spine disorders and sinusitis; misdiagnoses were more frequent in NRNRM and ResM than in RefM (31.1%, 28.5%, and 15.1%, respectively; p = 0.025). Misdiagnosis rates were not influenced by age, sex, disease duration, or comorbidities.ConclusionsDiagnostic tests use and misdiagnoses are highly prevalent in all the three groups of individuals with ResM, RefM, and NRNRM with some differences across the three groups that may depend on multiple factors. Our findings emphasize a need for better diagnostic accuracy and care pathway across the entire spectrum of migraine, to avoid unnecessary diagnostic tests and misdiagnoses.