Meconnaissance in Headache Disorders: Does the ICHD3 Inherently Allows for Misrecognition in Cases of Multiple Headaches?

BackgroundIn clinical circumstances with more than one headache disorders, misrecognition can occur if each headache disorder is not separately and individually evaluated. For example, consider the case of a patient with baseline tension type headaches lasting hours who now develops cluster headaches with nausea. Merging the characteristics of both disorders may yield the illusion of migraine. Do these types of misrecognitions occur necessarily because of ICHD3 criteria? Are there combinations of ICHD3 criteria, if any, which necessarily yield this type of misrecognition? ObjectiveThis work seeks to determine whether new, unintended diagnosis, can be arrived when one merges two ICHD3 diagnoses. MethodsWe translated ICHD3 primary headache disorders, as well as headache phenotypes closely mimicking ICHD3 criteria, as numerical data using prime encoding method. We then model the encoding of two concurrent diagnoses in an individual by multiplying all pairing of ICHD3 encoding. We then diagnose the result algorithmically to see which pairings, if any, generate "new"/" illusionary" diagnoses. ResultsA total of 117,526 phenotypes were generated. After duplicate pairing of diagnoses were removed, we derived a total of 72 pairings of unique ICHD3 diagnoses that yield a "new" diagnosis. Thirty-seven (51%) of these pairings were not judged to be "illusionary": they simply arise from our models idiosyncrasy of encoding chronic migraine without encoding migraine with or without aura explicitly. Of the rest, 23 pairings involve combining paroxysmal hemicrania with either a longer or shorter duration headache. We further generalize the condition under which the above "illusionary" diagnosis occurs as a mathematical observation. ConclusionMisrecognition arises naturally if diagnostic criteria consist solely of characteristics from another headache disorder or a combination of two headache disorders. Specifically, combining headaches with different duration and/or frequency are most likely to yield these "illusionary" diagnoses.