Migraine-like headaches: a systematic review of secondary etiologies, clinical features and therapeutic patterns (1977-2024)
Abstract
INTRODUCTION: Secondary headaches presenting similar clinical findings to migraine are known as migraine-like headaches. Currently, there is no broad consensus regarding their prevalence, characteristics, or underlying causes. Existing evidence is based primarily on descriptive studies and a single systematic review, with vascular, traumatic, and epileptic seizures as the most frequent causes. The aim of this systematic review was to describe and analyze secondary etiologies behind migraine-like headaches, including their epidemiological, clinical, and therapeutic characteristics.
METHODOLOGY: A database search of studies between 1977 and 2024 was conducted in February 2025 on EBSCO, SCOPUS, PubMed, and Web of Science using the terms "migraine-like" or "migraine mimic". Included articles were human observational studies and case reports that documented a migraine-like headache with a diagnosed underlying cause. Articles lacking explicit causality, as well as review and experimental studies were excluded. Data on demographics, clinical features, etiology, imaging, and treatment were extracted and analyzed. Etiologies were categorized into vascular, neoplastic, traumatic, epileptic, autoimmune, infectious and others. Sensitivity analysis (SA) was performed using low-bias concern studies.
RESULTS: Of 745 studies retrieved, 220 met inclusion criteria, totaling 4,422 patients (mean age 33.7 years, 63.4% female). Most presented severe (68.8%), unilateral (66.9%), gradual onset…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,422 participants or records.
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