Purpose of Review

This review details the frequency of and ways in which migraine can be both an ischemic stroke/transient ischemic attack mimic (false positive) and chameleon (false negative). We additionally seek to clarify the complex relationships between migraine and cerebrovascular diseases with regard to diagnostic error.

Recent Findings

Nearly 2% of all patients evaluated emergently for possible stroke have an ultimate diagnosis of migraine; approximately 18% of all stroke mimic patients treated with intravenous thrombolysis have a final diagnosis of migraine. Though the treatment of a patient with migraine with thrombolytics confers a low risk of complication, symptomatic intracerebral hemorrhage may occur. Three clinical prediction scores with high sensitivity and specificity exist that can aid in the diagnosis of acute cerebral ischemia. Differentiating between migraine aura and transient ischemic attacks remains challenging. On the other hand, migraine is a common incorrect diagnosis initially given to patients with stroke. Among patients discharged from an emergency visit to home with a diagnosis of a non-specific headache disorder, 0.5% were misdiagnosed. Further development of tools to quantify and understand sources of stroke misdiagnosis among patients who present with headache is warranted.

Summary

Both failure to identify cerebral ischemia among patients with headache and overdiagnosis of ischemia can lead to patient harms. While some tools exist to help with acute diagnostic decision-making, additional strategies to improve diagnostic safety among patients with migraine and/or cerebral ischemia are needed.

中文翻译：

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作为中风模仿物和中风变色龙的偏头痛。

审查目的

这篇综述详细介绍了偏头痛可以是缺血性中风/短暂性脑缺血发作模仿物（假阳性）和变色龙（假阴性）的频率和方式。我们还寻求就诊断错误来阐明偏头痛和脑血管疾病之间的复杂关系。

最近的发现

紧急评估可能偏头痛的所有患者中，将近2％最终诊断为偏头痛。接受静脉溶栓治疗的所有卒中模仿患者中约有18％最终诊断为偏头痛。尽管用溶栓剂治疗偏头痛患者的并发症风险较低，但可能会出现症状性脑出血。存在三个具有高敏感性和特异性的临床预测评分，可以帮助诊断急性脑缺血。区分偏头痛先兆和短暂性脑缺血发作仍然具有挑战性。另一方面，偏头痛最初是中风患者的常见错误诊断。在因急诊出院而诊断为非特异性头痛疾病的患者中，有0.5％被误诊。

概要

未能在头痛患者中识别脑缺血和对缺血的过度诊断都可能导致患者伤害。尽管存在一些有助于做出急性诊断决策的工具，但仍需要其他策略来提高偏头痛和/或脑缺血患者的诊断安全性。