EHMTI-0035. "Cervical pain" study in an Italian tertiary referral headache center

Introduction

The majority of migraine patients remain undiagnosed or misdiagnosed in Italy (Cevoli et al. 2009). In our experience, many patients affected by migraine self-diagnose it as 'cervical pain syndrome' (CP) assuming cervical spine pathology as the cause.

Aim

To phenotype and classify, in a tertiary referral headache center, the headache types of patients with self-diagnosed CP, and to describe this sample of patients.

Methods

All patients aged 18 to 75yo, referred to Mondino Headache Center for a first visit for headache, completed a questionnaire about CP. A detailed history was taken and a neurological exam was performed in each patient. Brain and cervical imaging were performed when deemed necessary. All patients finally received a diagnosis based on ICHD-IIIβ criteria.

Result

85 patients completed the questionnaire: 47 were suffering from self-diagnosed CP, 3 had suffered from self-diagnosed CP, 35 never had self-diagnosed CP. In all of 50 CP descriptions, the pain involved the head. ICHD-IIIβ diagnoses included migraine without aura (n=30), migraine with aura (1), probable migraine without aura (n=4), chronic migraine (n=7), medication overuse headache/chronic migraine (n=5), tension type headache (n=2), hemicrania continua (n=1), no patient presented with a phenotype suggestive of cervicogenic headache. 24 out of 50 patients with CP answered the question 'who did tell you that these attacks are CP?' with: general practitioner/medical specialist. The majority of these patients underwent exams without a clear indication and ineffective treatment.

Conclusion

To the best of our knowledge, this is the first study that systemically assessed the headache phenotype of patients with self-diagnosed CP. The results suggest that the phenomenon of self-diagnosing CP is very common in Italy, even in patients referred to a tertiary headache center. The majority of these patients suffer from typical migraine attacks, without any evidence of pathological conditions of the cervical spine.

No conflict of interest.