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The Prevalence of Symptoms Before, During and
After Attacks in a Population of ISH Migraineurs
with Concomitant Headache Diagnosis
Curtis P. Schreiber, M.D., Roger K. Cady, Mary S. Richardson,
Pharm.D., Stephen O’Quinn, Pharm.D.
Posted November 2002  
Presented at: AHS Conference, Seattle WA, June 21-23, 2002


  • Only 48% of migraineurs, as defined by the International Headache Society (IHS) diagnostic criteria, have received a physician diagnosis of migraine.
  • Of the approximately 12 million migraine sufferers who remain undiagnosed, 3.8 million are diagnosed with sinus or tension type headache and approximately 8.4 million report they have never received a physician diagnosis of migraine, sinus, tension-type or cluster headache.
  • A review of the common symptoms reported at all headache phases and their relationship to reported headache diagnoses may help to explain these diagnostic dilemmas.

Objective:   To evaluate the headache symptoms in a population of migraineurs meeting IHS criteria who reported their symptoms and the headache diagnoses they received from their physician and to explore the relationship between their symptoms and diagnosis.


  • Fifty-four percent of the 4,000 surveys were returned
  • Seventy-four percent of the returned surveys were evaluable
  • 1,182 subjects reported symptoms and a physician headache diagnosis
  • 80% of respondents were female
  • 91% of respondents were Caucasian
  • Mean age was 43 years
  • Had suffered with migraine for a mean of 19 years

Respondents were divided into groups representing their reported physician diagnoses of headache: Migraine only (n=337), Sinus only (n=99), Tension only (n=53), Sinus & Tension (n=67), Migraine & Sinus (n=192), Migraine & Tension (n=97), Migraine & Tension & Sinus (n=282)

  • Similar symptoms were reported before and during the headache, regardless of the patient reported headache diagnosis
  • Pain was the most bothersome symptom reported by patients
  • Tiredness and fatigue was the most prominent symptom after the headache went away.


  • Similar headache symptoms were reported by subjects with migraine as defined by IHS diagnostic criteria, before and during the headache, regardless of the headache diagnoses they reported receiving from their physician.
  • Although this study does show statistically significant differences in select symptoms between diagnostic groups, the overall similarity of symptoms described across all diagnostic groups suggests that there are other factors that shape physician diagnoses.
  • Differences in the clinical presentations of headache that shape physician diagnostic decision making require further investigation.
  • The commonality of symptoms across diagnostic groups suggest that broader awareness of the scope of migraine symptomatology may improve diagnosis.