Migraine Differential Diagnosis

When considering a differential diagnosis for migraine, it's crucial to evaluate a range of potential causes to ensure accurate diagnosis and appropriate treatment. The differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Migraine itself: This is the most straightforward diagnosis when symptoms align with the classic presentation of migraine, including unilateral headache, photophobia, phonophobia, and sometimes aura.
• Other Likely Diagnoses
  • Tension headache: Often presents with bilateral headache and may lack the severe intensity or associated symptoms of migraine.
  • Cluster headache: Known for severe, unilateral orbital or periorbital pain, typically without the visual aura of migraine.
  • Sinus headache: Headache associated with sinusitis, which may mimic migraine but is usually accompanied by facial pain and other sinusitis symptoms.
• Do Not Miss Diagnoses
  • Subarachnoid hemorrhage: A life-threatening condition that can present with a sudden, severe headache (often described as "the worst headache of my life"), which might be mistaken for a migraine.
  • Temporal arteritis: Especially in older adults, this condition can cause headache and may lead to blindness if not promptly treated.
  • Stroke or transient ischemic attack (TIA): While less common, stroke or TIA can present with sudden onset of headache, among other neurological symptoms.
  • Idiopathic intracranial hypertension (IIH): Characterized by increased intracranial pressure without a detectable cause, often presenting with headache and visual disturbances.
• Rare Diagnoses
  • Trigeminal neuralgia: A condition causing intense pain along a branch of the trigeminal nerve, which could be mistaken for migraine due to its severe, episodic nature.
  • Hypnic headache: A rare headache disorder that occurs only during sleep and wakes the patient, potentially confused with migraine due to its episodic nature.
  • Cervicogenic headache: Originates from the cervical spine and its structures, which might mimic the unilateral pain of migraine.

Each of these diagnoses has distinct characteristics, and a thorough medical history, physical examination, and sometimes additional diagnostic tests are necessary to differentiate them from migraine and each other.