Factors associated with delayed diagnosis of migraine: A hospital-based cross-sectional study

Context: Migraine is common debilitating disorders, affecting 10 to 20% of the world's population. However, proper diagnosis is delayed due to many factors. Aims: To determine various factors associated with delayed diagnosis of migraine. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: Patients attending Neurology OPD of AIIMS Bhopal and satisfying diagnostic criteria of the International Headache Society (ICHD-3 beta) for migraine were selected for study. MIDAS, MINI, and ROME-III were used. First diagnosis was considered as "Appropriate" if patients were previously diagnosed as "migraine" or getting treatment for it; otherwise labeled as "Inappropriate." Statistical Analysis: Associations were tested by Chi-square, t-test, or Mann-Whitney test. Logistic regression analysis was used for identifying independent factors associated with inappropriate diagnosis. Results: Hundred patients (female = 77) of migraine were included. Mean age (SD) was 32.42 (10.74). Diagnosis was "inappropriate" in 65 patients. Number of inappropriate diagnosis/appropriate diagnosis was 10/40 (25%) by neurologists; 35/39 (89.3%) by physicians; 18/18 (100%) by ophthalmologists. Factors associated with "Inappropriate Diagnosis" were "Neurologist vs Other Doctors" {10 (25%) vs 55 (91.7%), P < 0.001}; throbbing vs other types of headache {51 (60.7%) vs 14 (87%), P = 0.047}; and temporal vs other sites {9 (42.9%) vs 56 (70.9%), P = 0.017}. Patients with "Inappropriate Diagnosis" had to expend more money {7000 (4,500; 12,500) vs 4000 (1000, 6000), P < 0.01; median (interquartile range) all in INR}. Other clinical parameters including vertigo, cervical pain, anxiety, depression, and functional gastrointestinal symptoms were not associated with delayed diagnosis. Conclusion: Delayed diagnosis and misdiagnosis is very frequent in migraine, leading to financial burden to patients. Management of common disorders like migraine should be addressed in undergraduate medical teaching curriculum.