Last updated: Apr 23, 2008

Migraine attacks differ from individual to individual, and that makes these agonizing headaches surprisingly easy to misdiagnose.



The "aura" famously associated with migraines only happens in about 15% to 20% of sufferers. And patients who experience "whole-head headaches"—not just a one-sided headache—sometimes incorrectly receive a tension headache diagnosis. Because migraine sufferers often have stuffy noses, and experience pressure over their foreheads, some are shuffled into the sinus headache crowd. A key difference is that a true sinus headache—that is, a headache associated with a sinus infection—would have green or yellow nasal discharge and come with a fever.

Stewart Tepper, MD, director of research at the Center for Headache and Pain at the Cleveland Clinic Neurological Institute, also blames time pressures on physicians and patient-doctor communication. "Most of the time people go to primary care doctors, and they have a list of problems and they may not even mention headache until they're walking out," says Dr. Tepper. "It's referred to as the 'doorknob diagnosis.' They'll turn and say, 'By the way, I'm also having problems with my headaches.' And the primary care doctor has already spent seven minutes or 12 minutes with a patient and they don't pay much attention to it."

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If you suspect you've been misdiagnosed, seek out a headache specialist. Visit the American Headache Society Committee for Headache Education, which has a database of member headache specialists across the country, the National Migraine Association or the National Headache Foundation.

The phrase "headache specialist" can be confusing. A few groups offer certification, but the number of certified physicians is perhaps only in the hundreds, and there are many headache doctors who don't have it. Suzanne Simons, executive director of the Chicago-based National Headache Foundation, suggests that patients take a pro-active approach in choosing a specialist—asking questions, such as how much of a doctor's practice is dedicated to treating headaches, or whether they publish research on headaches—to get a feel for a physician's involvement in the field.

While the majority of headache specialists are neurologists, there are also internists, anesthesiologists, and family practice doctors who work in this area. Many insurance companies will cover these types of specialists. Depending on your plan, you may need a referral from your family doctor. But some doctors may not take insurance, so check ahead.