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A Comparison of Symptom-Based and Reported Physician Diagnosis

Richard B. Lipton, MD; Walter F. Stewart, PhD; David D. Celentano, ScD; Michael L. Reed, PhD

Arch Intern Med. 1992;152(6):1273-1278.

Abstract
Background.—
Although migraine headaches are a common cause of temporary disability, many people with migraine have not been diagnosed. In a sample of the US population, we sought to determine the proportion of migraineurs diagnosed by a physician and to identify the headache characteristics and sociodemographic profiles associated with undiagnosed migraine.

Methods.—
A mail questionnaire survey was sent to 15 000 US households, selected from a panel to be representative of the US population. Of a total study base population of 23 611, excluding 3043 subjects less than 12 years of age and respondents with unreported gender, we analyzed data for 20 468 subjects aged 12 to 80 years. Migraine diagnoses were assigned on the basis of reported symptoms by means of operational diagnostic criteria. Physician diagnosis of migraine was ascertained on the basis of self-report.

Results. —
Forty-one percent of female and 29% of male migraineurs reported having been diagnosed by a physician. Diagnosis was more likely in females, in people with high income levels, and in individuals who reported migraine associated with aura, vomiting, or disability. Of the undiagnosed subjects, 80% experienced at least some headacherelated disability.

Conclusions. —
Results of this survey indicate that the majority of people with migraine in the United States do not report having been diagnosed by a physician. Given the high proportion of undiagnosed subjects with headache-related disability, efforts to improve the diagnosis and treatment of migraine are recommended.

(Arch Intern Med. 1992;152:1273-1278)

Author Affiliations
From the Department of Neurology, Albert Einstein College of Medicine, Headache Unit, Montefiore Medical Center, Bronx, NY (Dr Lipton); Department of Epidemiology (Dr Stewart) and Department of Health Policy and Management (Dr Celentano), The Johns Hopkins University, Baltimore, Md; and Glaxo Inc, Research Triangle Park, NC (Dr Reed).

Footnotes
Accepted for publication November 16, 1991.

Reprint requests to Department of Neurology/Headache Unit, Montefiore Medical Center, 111 E 210th St, New York, NY 10467 (Dr Lipton).

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