Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort.

BACKGROUND AND PURPOSE: Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS: This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. RESULTS: In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. CONCLUSIONS: Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.

[Cutaneous microcirculation in systemic sclerosis. Morpho-functional research using capillaroscopy and laser-Doppler]. / Il microcircolo cutaneo nella sclerosi sistemica. Ricerche morfofunzionali mediante capillaroscopia e laser-Doppler.

Our previous researches proved that, in patients affected by Raynaud disease, microcirculatory alterations were greater in those cases in which the small vessels showed evocative appearances of a sclerodermatous connectivopathy. In this study we evaluated cutaneous microvasculature in 18 patients suffering from clear systemic sclerosis, compared with a group of 16 subjects affected by primitive Raynaud disease and a group of healthy subjects. We used videocapillaroscopy and laser-Doppler fluxmetry for morphological and functional study respectively. In patients affected by systemic sclerosis the rest flow was clearly reduced and morphological pattern of cutaneous small vessels deranged. The response to ischemic test allowed us to subdivide the skin-bounds in two subgroups: "no responders" 8 subjects (44%), in which reactive hyperaemia was completely absent, "responders" 10 patients (56%) in which the hyperaemia was completely overlapped with that of the two other groups, but with longer reaction times. In skinbounds the capillaroscopic pattern was clearly severe in comparison with other two groups (18.8 +/- 5.7 vs 5.7 +/- 2.3 and 3.6 +/- 1). Thus, in advanced stage of the pathology, is microangiopathy (in its tromboischemic and inflammatory aspects) that plays a very important role in the development of organ damage. Therefore, all those clinical and instrumental tests which may allow a differential early diagnosis between a primitive and a secondary Raynaud phenomenon be done, for its prognostic value in connection with the appearance of systemic sclerosis.