Highlights of the 45th Meeting of the American Headache Society
Highlights of the 45th Meeting of the American Headache Society
This material is part of the scientific program of the 45th Annual Scientific Meeting of the American Headache Society, held from June 21-23, 2003, in Chicago, Illinois. This report reviews presentations related to migraine diagnosis, sensitization and headache, menstrual migraine, preventive treatment, organic headache, and pathophysiology.
Despite its relatively high prevalence, migraine is an underdiagnosed disorder. Because most patients who seek medical care for headaches present in the primary care setting, a self-administered screening instrument could improve recognition of migraine both among patients and their primary care providers, thereby improving the treatment of migraine.
In a study presented at this year's meeting, Lipton, from the Albert Einstein College of Medicine, Bronx, New York, and colleagues established the validity and reliability of a brief, self-administered screening instrument for identifying patients with migraine in the primary care setting. Patients who had visited outpatient primary care for any reason; experienced headaches that interfered with their work, study, or quality of life; or those who presented for a discussion with their physician about their headaches, and who completed a screening questionnaire, were included in the study. Eligible participants were then seen by headache specialists who assigned diagnoses based on International Headache Society (IHS) criteria; specialists were blinded to the initial screening results.
The 9-item screening instrument included 8 items that paralleled the IHS features that defined migraine (pain descriptors, aura, nausea, photophobia, and phonophobia), and 1 item quantified the patient's disability. A total of 433 patients completed the screening and headache specialist evaluations. Of the 9 screening questions, a subset of 3 questions describing disability, nausea, and sensitivity to light performed best for predicting migraine diagnosis, with a sensitivity of 0.81 (95% CI, 0.77 to 0.85), a specificity of 0.75 (95% CI, 0.64 to 0.84), and a positive predictive value of 93.3% (95% CI, 89.9 to 95.8). The sensitivity and specificity of these 3 questions held up regardless of sex, age, presence of other headache, or previous diagnoses. Because this tool is easy to use, quick to administer, and highly accurate, it could significantly improve the recognition of migraine headaches in the primary care setting.
This material is part of the scientific program of the 45th Annual Scientific Meeting of the American Headache Society, held from June 21-23, 2003, in Chicago, Illinois. This report reviews presentations related to migraine diagnosis, sensitization and headache, menstrual migraine, preventive treatment, organic headache, and pathophysiology.
Despite its relatively high prevalence, migraine is an underdiagnosed disorder. Because most patients who seek medical care for headaches present in the primary care setting, a self-administered screening instrument could improve recognition of migraine both among patients and their primary care providers, thereby improving the treatment of migraine.
In a study presented at this year's meeting, Lipton, from the Albert Einstein College of Medicine, Bronx, New York, and colleagues established the validity and reliability of a brief, self-administered screening instrument for identifying patients with migraine in the primary care setting. Patients who had visited outpatient primary care for any reason; experienced headaches that interfered with their work, study, or quality of life; or those who presented for a discussion with their physician about their headaches, and who completed a screening questionnaire, were included in the study. Eligible participants were then seen by headache specialists who assigned diagnoses based on International Headache Society (IHS) criteria; specialists were blinded to the initial screening results.
The 9-item screening instrument included 8 items that paralleled the IHS features that defined migraine (pain descriptors, aura, nausea, photophobia, and phonophobia), and 1 item quantified the patient's disability. A total of 433 patients completed the screening and headache specialist evaluations. Of the 9 screening questions, a subset of 3 questions describing disability, nausea, and sensitivity to light performed best for predicting migraine diagnosis, with a sensitivity of 0.81 (95% CI, 0.77 to 0.85), a specificity of 0.75 (95% CI, 0.64 to 0.84), and a positive predictive value of 93.3% (95% CI, 89.9 to 95.8). The sensitivity and specificity of these 3 questions held up regardless of sex, age, presence of other headache, or previous diagnoses. Because this tool is easy to use, quick to administer, and highly accurate, it could significantly improve the recognition of migraine headaches in the primary care setting.
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