Accuracy of migraine diagnosis and treatment by neurologists in the Baltic states: e-survey with clinical case challenge

Background: Underdiagnosis of migraine causes a significant health burden, including lower quality of life, excessive medication use, and a delay in effective treatment. The purpose of this study was to evaluate migraine diagnosis accuracy and to review the treatment approaches used by neurologists in the Baltic states. Methods: The research was conducted as an anonymous e-survey with four cases in March and April 2021. Results: 119 practicing adult neurologists have participated. The migraine diagnostic accuracy was 63.2%. The most commonly used diagnostic criteria were moderate/severe pain, unilateral pain, and disruption of daily activities. Diagnostic accuracy did not differ significantly between neurologists who always use ICHD-3 criteria and those who don’t (68.4% vs. 58.5%, p = 0.167). It was higher in neurologists who were working in headache centers (91.7% vs. 60.9%, p = 0.012), and was related to a higher percentage of migraine diagnoses in all consulted headache patients (R ² = 0.202, adjusted R ² = 0.195, p < 0.001), prophylaxis with onabotulinumtoxin A [OR = 4.332, 95% Cl (1.588–11.814)], and anti-CGRP monoclonal antibodies [OR = 2.862, 95% Cl (1.186–6.907)]. Conclusions: Migraine diagnostic accuracy is improved through practical patient counseling and modern treatment prescription. Although the neurologists in the Baltic states follow current European guidelines, there is room for improvement in diagnostic accuracy to reduce migraine burden.