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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Headache+Pain
2025 ; 26
(1
): 229
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Migraine-like headache attributed to a causative disorder: primary migraine or
secondary headache with a migraine-like phenotype?
#MMPMID41131473
Lebedeva ER
; Schwedt TJ
; Chong CD
; Gilev DV
; Hansen NS
; Jensen RH
; Schytz HW
; Olesen J
J Headache Pain
2025[Oct]; 26
(1
): 229
PMID41131473
show ga
BACKGROUND: Migraine-like headaches can accompany or be the initial manifestation
of many neurological disorders. When a migraine-like headache develops or worsens
in the presence of another neurological disorder, there is often uncertainty
about whether the headache is true migraine (i.e., the primary headache) or is a
secondary headache with migraine-like symptoms. To answer this question, we
analyzed headache characteristics and the effect of treatment in several
neurological disorders. MATERIALS AND METHODS: The study was a retrospective
analysis of five existing datasets collected by the authors: 1) 670 patients with
acute ischemic cerebrovascular disease (550 patients with first-ever ischemic
stroke, mean age 63.1 years, 46% females and 120 patients with transient ischemic
attacks-TIA, mean age 56.1 years, 54.2% females); 2) 199 patients with
intracranial saccular aneurysms (mean age 43.2 years, 52% females); 3) 77
patients with newly diagnosed definite idiopathic intracranial hypertension (IIH)
(mean age 28.8 years, 96% females); 4) 169 patients with post-traumatic headache
(PTH) attributed to mild traumatic brain injury (mTBI) (mean age 41.5 years,
52.1% females); 5) 59 patients with PTH followed prospectively with a focus on
treatment response to prophylactic migraine medication (mean age 37.1 years, 78%
females). Detailed information about headache characteristics and outcomes were
collected. RESULTS: Our results demonstrate that a headache phenotypically
fulfilling the diagnostic criteria for 1.1 Migraine without aura and/or 1.2
Migraine with aura can be due to a causative disorder with the following
incidence: 13.3% in TIA, 6.9% in ischemic stroke, 44.2% in saccular intracranial
aneurysm, 51.9% in IIH, 70.8% in acute PTH, and 90% in persistent PTH. Among
individuals who had acute headache following stroke, 45.4% developed persistent
headache. These headaches attributed to a secondary cause often responded poorly
to migraine treatment, at least suggesting that they differ from primary
migraine. The migraine-like headaches disappeared after treatment or remission of
the causative disorder in 38.5% of cases with IIH, and 47.7% after clipping of
intracranial aneurysms, an outcome that would not be expected if the headaches
were primary migraine. CONCLUSION: Our study supports the ICHD-3 statement that
migraine-like headache attributed to a secondary cause should be coded as a
secondary headache of the migraine type and that it is a migraine mimic
attributed to a causative disorder.