The misdiagnosis of migraine is common. Around half of people presenting with headache pain are not diagnosed correctly as to its cause. So, there is already an issue present that can become more challenging for women.
Another issue women face is the stereotype of hysteria that still holds sway in some medical practices. Unfortunately, even female physicians seem to look at women's problems, not as genuine medical conditions, but as ways to get attention. Women are told they’re fine, just get some rest tonight and all will be well.
Some are told it's all in their heads. Well, yeah…it's a headache! Still, the feeling that they are not heard or listened to by the medical establishment is still a problem for women. Unfortunately, the typical migraine sufferer is a working-age woman who may seem perfectly fine other than the headache pain.
Headache misdiagnoses are also due to other issues, including conditions that mimic migraines, a lack of understanding of typical symptoms of migraine in comparison to other headache-causing conditions, or the fact that women are under-represented in clinical trials for medications and medical conditions.
Here’s a closer look at reasons headaches are misdiagnosed in women.
Underrepresentation in Clinical Trials and Studies
The medical establishment has treated women as abnormal men for years. This is reflected in healthcare processes and treatments that are studied and proven out exclusively on male subjects. Then the results are applied to women. It seems that normal means a 70 kg male, and a woman is a deviation from that normal.
Why are women underrepresented?
- The urge to protect fertility in females of childbearing age.
- Researchers don’t use a diversity model to create study groups and clinical trials.
- Women are considered exactly like men, only smaller on average.
- Fewer studies are done on issues more exclusive to women, or that may be caused by hormonal shifts.
It’s a sad truth that, even now, women must fight for a correct diagnosis because of outdated notions.
Conditions Mimicking Migraines and Vice Versa
Headaches are common and tend to be non-specific symptoms. While we understand more about various headache conditions such as migraines than we used to, it’s still challenging to tease out all the required information to make a confident and appropriate diagnosis.
Also, many conditions mimic migraines, and sometimes, it's the other way around. There are primary and secondary headache disorders that can result in an incorrect diagnosis of migraine.
Primary conditions are those that are true headache disorders in their own right.
- Trigeminal autonomic cephalgias, including cluster headaches, paroxysmal hemicrania, hemicrania continua, and SUNCT/SUNA or short-lasting unilateral neuralgiform headache attacks with or without conjunctival injection.
- New daily persistent headache (NDPH)
- Hypnic headache
- Other headaches from tension, anxiety disorders, Meniere’s disease, and post-concussion syndrome
Cluster headaches are relatively rare, with only 5% of the US population suffering from the condition. Since migraine is much more common, cluster headaches may be misdiagnosed as migraines. Cluster headaches can include up to eight attacks daily or almost daily, and may last from 15 minutes to three hours.
Since cluster headaches are a rare issue, it isn’t surprising that few healthcare practitioners have little experience with it and tend to diagnose migraines.
Secondary conditions that mimic migraines are those that present severe headaches as a feature of the disease.
- Vascular secondary headaches from arterial dissection, giant cell arteritis, thunderclap headache, stroke or other vascular abnormalities, and transient ischemic attacks.
- Headache related to cerebrospinal fluid pressure, including headaches caused by spinal fluid sampling.
- Infectious secondary headaches caused by sinus infections or other contagious illnesses.
- Toxic and metabolic headaches
- Headaches associated with neoplasm
- Other causes from medication overuse and hypertension to epilepsy.
A word about sinus headaches. Sinus pain without infection is incredibly rare. If you are diagnosed with a sinus headache without evidence of sinus infection, you may need a second opinion or simply ask the doctor to take a second look.
Everyone’s Worst Nightmare: A Brain Tumor Diagnosed as Headache
Brain tumors are also relatively rare, and headache pain isn’t unusual. But when a patient has been put off repeatedly with little to no treatment, finally finding out the problem is a brain tumor is distressing in the extreme.
In this particular story, a 19-year-old woman presented with symptoms of a migraine. She was told it was just a headache caused by tension or stress. (So even if it was a migraine, she was still not diagnosed or treated correctly.) As time went on, her symptoms began to include nausea, vomiting, and fatigue, along with the excruciating headaches.
Then she developed a whooshing sound in her right ear that turned out to be due to pressure in her head (determined after the tumor diagnosis). Still, her problems were dismissed as stress.
It was when she developed double-vision and consulted an optometrist that she was finally diagnosed correctly. Her optic nerve was swollen, and she was referred for a CT scan. It showed she had a frontal lobe lesion from a cancerous tumor called gemistocytic astrocytoma.
After surgery to remove the tumor, her pain resolved somewhat. Unfortunately, the tumor returned later. At least this time, the doctor knew what it was.
There were several factors the patient felt had worked against her obtaining a correct diagnosis. At the top of the list was that she was a woman. She was young, healthy, and took a contraceptive that caused headaches in some users. When the headaches were blamed on it, she pointed out she had taken the medication for two years before the headaches began.
The medical establishment is increasingly aware of the lack of appropriate diagnoses and treatment in women. Many are taking more care to obtain a full health history and listen to what a woman has to say about her own body.
Clinical trials and research studies are beginning to reach out to women for participation. They finally acknowledge that a woman is not a defective or small man. Women react differently than men to many treatments and medications, and they often present with different symptoms for common issues like heart attacks.
More is being learned about conditions specific to women as well. Migraines that can be attributed to hormonal shifts are more often appropriately diagnosed. Still, there is a way to go, not only in our understanding of headaches in women but in learning more about migraines, what causes them, and how to diagnose them more quickly.