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Debunking myths in headache diagnosis for the pain practitioner
  1. Hsiangkuo Yuan1,
  2. Samantha Strutner2,
  3. Clara Yuh3,
  4. Suwarna Anand4,
  5. Gaurav Chauhan5,
  6. Anand Prem4,
  7. Shalini Shah6 and
  8. Nathaniel M Schuster7
  1. 1Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2School of Medicine, University of California, Irvine, Irvine, California, USA
  3. 3Department of Physical Medicine & Rehabilitation, University of California, Irvine, Irvine, California, USA
  4. 4Department of Anesthesiology, University of Mississippi University Hospital, Jackson, Mississippi, USA
  5. 5Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6Department of Anesthesiology & Perioperative Care, University of California, Irvine, Orange, California, USA
  7. 7Headache and Pain Neurologist, Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
  1. Correspondence to Dr Nathaniel M Schuster, Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, CA 92037, USA; nmschuster{at}


With headache being one of the most common chief complaints, it is essential for pain practitioners to interpret and differentiate a variety of headache characteristics to accurately diagnose and treat specific headache disorders. Certain misconceptions often lead to misdiagnosis. This article presents and discusses six myths about several common headache disorders (migraine, tension-type headache, cluster headache, cervicogenic headache, sinus headache, and occipital neuralgia) often encountered in clinical practice. The discussion is based primarily on the International Classification of Headache Disorders, 3rd edition and the latest studies. Recognizing and understanding the intricacies behind key headache diagnoses will help providers devise appropriate plans to better care for their patients.

  • migraine
  • tension-type headache
  • cluster headache
  • cervicogenic headache
  • occipital neuralgia

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  • Twitter @ShaliniShahMD, @NatSchusterMD

  • Contributors HY and SS contributed to conception and design. HY, SS, CY, SA, GC, AP, SS and NMS contributed to acquisition of data. HY, SS, CY, SA, GC, AP, SS and NMS contributed to drafting the article. HY, SS, CY, SA, GC, AP, SS and NMS contributed to revision for intellectual content. NMS contributed to final approval of completed article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Within the past 24 months, HY has received funding from NIH (R44NS115460); institutional support for serving as an investigator from Teva, Abbvie, Trillen, Thermaquil; consultant fees from Salvia, Pfizer, Cerenovus; and royalties from Cambridge University Press and MedLink. NS has received compensation from Eli Lilly & Co., Averitas, ShiraTronics, Syneos, Schedule 1 Therapeutics, and Vectura Fertin and research funding from Migraine Research Foundation, Novaremed, UCSD Academic Senate, UCSD Department of Anesthesiology RAG, and NIH CTSA Grant UL1TR000100. SS received consulting honorarium from Allergan.

  • Provenance and peer review Not commissioned; externally peer reviewed.