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Migraine Misdiagnosed as Sinus Headache — SCE Neurology MCQ

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HardHeadache & Facial PainMigraine Misdiagnosed as Sinus HeadacheSCE Neurology

A 38-year-old has 8-hour unilateral throbbing headaches with nausea, photophobia and worsening on movement. During attacks she also develops ipsilateral tearing and nasal blockage, but she prefers to lie still. Which diagnosis best integrates the phenotype?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Migraine with cranial autonomic symptoms

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · A = shown as D · B = shown as E

A is correct: migraine may include cranial autonomic symptoms; the 8-hour duration, nausea, photophobia and movement avoidance remain migrainous. B lasts 15–180 minutes and usually causes agitation. C produces shorter, frequent attacks with absolute indometacin response. D lasts seconds to minutes. E is continuous with superimposed exacerbations and absolute indometacin response.

Reference: ICHD-3: migraine without aura: https://ichd-3.org/1-migraine/1-1-migraine-without-aura/ ICHD-3: cluster headache: https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-1-cluster-headache/