A self-administered screener for migraine in primary care

TLDR

Migraine is a common and disabling disorder that is frequently underdiagnosed in primary care settings. This study aimed to validate and assess the reliability of a brief, self‑administered migraine screener for patients presenting with headache complaints in primary care. A total of 563 headache‑complaining patients completed the screener, and 451 were subsequently evaluated by a headache specialist using International Headache Society criteria via a semi‑structured interview. The three‑item screener (disability, nausea, photophobia) achieved 81 % sensitivity, 75 % specificity, 93 % PPV, and a kappa of 0.68, with consistent performance across age, sex, and comorbidities, confirming its validity and reliability for improving migraine detection in primary care.

Abstract

<b><i>Background:</i></b> Migraine is a highly prevalent and disabling illness that remains substantially undiagnosed in primary care. Because of the potential value of a screening tool, the current study was designed to establish the validity and reliability of a brief, self-administered migraine screener in patients with headache complaints in the primary care setting. <b><i>Methods:</i></b> A total of 563 patients presenting for routine primary care appointments and reporting headaches in the past 3 months completed a self-administered migraine screener. All patients were then referred for an independent diagnostic evaluation by a headache expert, of whom 451 (80%) completed a full evaluation. Migraine diagnosis was assigned based on International Headache Society criteria after completing a semi-structured diagnostic interview. <b><i>Results:</i></b> Of nine diagnostic screening questions, a three-item subset of disability, nausea, and sensitivity to light provided optimum performance, 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 positive predictive value of 0.93 (95% CI, 89.9 to 95.8). Test-retest reliability was good, with a kappa of 0.68 (95% CI, 0.54 to 0.82). The sensitivity and specificity of the three-item migraine screener was similar regardless of sex, age, presence of other comorbid headaches, or previous diagnostic status. <b><i>Conclusions:</i></b> The three-item ID Migraine™ migraine screener was found to be a valid and reliable screening instrument for migraine headaches. Its ease of use and operating characteristics suggest that it could significantly improve migraine recognition in primary care.