Differential Diagnosis for Increased Migraine Frequency

The patient's history of migraines and recent increase in frequency of sumatriptan use suggests several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Medication Overuse Headache (MOH): This is the most likely diagnosis given the patient's increased use of sumatriptan, a common pattern seen in MOH. The frequent use of triptans can lead to a vicious cycle of headache relief followed by rebound headaches, necessitating more frequent medication use.

• Other Likely Diagnoses

  • Increased Migraine Frequency: This could be due to various factors such as hormonal changes, stress, sleep disturbances, or environmental factors. The increase in migraine frequency might not necessarily be related to the medication use but could be an exacerbation of the underlying migraine condition.
  • Stress or Lifestyle Changes: Significant changes in the patient's life, such as increased stress, changes in sleep patterns, or dietary factors, could contribute to the increased frequency of migraines.

• Do Not Miss Diagnoses

  • Secondary Headache Disorders: Although less likely, it's crucial not to miss secondary causes of headaches, such as temporal arteritis, especially if the patient is over 50, or other conditions like brain tumors, which can present with increased headache frequency.
  • Hypertension or Other Systemic Illnesses: Uncontrolled hypertension or other systemic illnesses could lead to an increase in headache frequency and should be considered, especially if there are other symptoms or risk factors present.

• Rare Diagnoses

  • Neurological Conditions: Rare neurological conditions such as Chiari malformation, idiopathic intracranial hypertension, or cerebral venous sinus thrombosis could present with increased headache frequency but are less likely without other specific symptoms or findings.
  • Other Rare Headache Disorders: Conditions like cluster headaches, although distinct in their presentation, could be considered if the headache pattern significantly deviates from typical migraines, especially with new or worsening symptoms.