Migraine: Or something else? Differential Diagnosis

Eyes and ocular appendages (H00-H59).

  • Ocular migraine (synonyms: Ophthalmic migraine; Migraine ophtalmique) – variant of migraine in which there are transient, bilateral visual disturbances (flickering, flashes of light, scotomas (restrictions of the visual field); similar to “normal” migraine with aura); often without headache, but sometimes with headache, which sometimes occurs only after the visual disturbances; duration of symptoms usually 5-10 minutes, rarely longer than 30-60 minutes Retinal migraine, in which only the retina, i.e. the retina at the back of the eye, is affected, must be distinguished from ocular migraine. i.e., the retina at the back of the eye, is affected – variant of migraine in which completely reversible monocular (“affecting one eye”), positive and/or negative visual phenomena (flickering, scotomas, or blindness) occur; these occur together with headaches that begin while the visual disturbances are still present or follow within 60 minutes
  • Glaucoma attack – eye disease with increased intraocular pressure.

Cardiovascular system (I00-I99)

  • Apoplexy (stroke) [migraine with aura is a “stroke chameleon,” meaning it suggests another condition that is actually apoplexy]
  • Arteriovenous malformations (AVM) – congenital malformation of the blood vessels in which the arteries are directly connected to the veins; these occur primarily in the CNS and facial skull areas
  • Sinus vein thrombosis (SVT) – occlusion of a cerebral sinus (large venous blood vessels of the brain arising from duraduplications) by a thrombus (blood clot); clinical picture: headache, congestive papules and epileptic seizures.
  • Vasculitis (vascular inflammation).
  • Cerebral venous and sinus thrombosis (CVT); symptoms: most severe, acute onset, circumscribed headache; possibly also focal or generalized cerebral deficits (incidence (frequency of new cases): < 1.5/100,000 per year).

Infectious and parasitic diseases (A00-B99).

Musculoskeletal system and connective tissue (M00-M99).

  • Arteritis temporalis (synonyms: Arteriitis cranialis; Horton’s disease; giant cell arteritis; Horton-Magath-Brown syndrome) – systemic vasculitis (vascular inflammation) affecting the arteriae temporales (temporal arteries), especially in the elderly.

Neoplasms – tumor diseases (C00-D48).

  • Brain tumors, unspecified
  • Nasal cavity tumors, unspecified
  • Paranasal sinus tumors, not specified

Psyche – nervous system (F00-F99; G00-G99).

  • Chronic paroxysmal hemicrania – hemiparetic headache; attacks spread throughout the year with a maximum of one month of headache-free time.
  • Chronic hemiparesis headache
  • End-menstrual migraine (EMM; English : Non-Hormonally Mediated Cyclic Headache) – headache attacks not classically at the beginning of the period (= menstrual migraine) but in the last days of menstruation; in 28 of the 30 EMM patients (93.3%) the ferritin value was below the threshold of 50 ng/ml (50% was even < 18 ng/ml). Patients with iron deficiency anemia also have a high frequency of migraine headaches
  • Encephalitis (brain inflammation).
  • Tension-type headache (tension headache).
  • Menstrual migraine (migraine without aura, whose attacks occur in at least two of three cycles in the days around menstruation (menstruation); frequency: about 10-15% of women).
  • SUNCT syndrome (shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating and rhinorrhea). – Headache with shorter attacks and higher frequency than cluster headache.
  • Trigeminal neuralgia – usually unexplained severe pain in the face due to irritation of a facial nerve.

Pregnancy, childbirth and puerperium (O00-O99)

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Traumatic corneal lesions – injuries to the cornea, due to an accident or surgery.