A Dog’s Breakfast
Q. What do diagnosing headache and migraine and a dog’s breakfast have in common?
A. It’s all over the place!
Diagnosing headache and migraine and associated challenges are expressed in a recent article by Sun-Edelstein et al 2008. Since the diagnostic classification was published, there have been many attempts to confirm or otherwise the accuracy of the criteria. Because of the multiple revisions since, there exists a great deal of controversy and significant confusion, with headache specialists unsure as to which criteria to use.
Many patients after having received an initial diagnosis, receive a second, with some getting 3-4 diagnoses! This is clearly unsatisfactory… and is the result of an unproved assumption. The various types of headache and migraine are not separate entities with different pathophysiological mechanisms, they are on a continuum… different expressions of a shared, common (and often worsening) disorder and that is a sensitised brainstem.