Change in intraindividual ICHD-II headache diagnosis over time: A follow-up of the DMKG headache study

Abstract

Background: Change in headache diagnoses over time within the same individual is not well studied in the adult population. In this study, we prospectively examined the individual variation of migraine and tension-type headache (TTH) diagnoses over time. Methods: As part of the epidemiological Deutsche Migräne und Kopfschmerzgesellschaft (DMKG) headache study, 1312 participants were personally interviewed and 1122 responded to a second mailed questionnaire 2.2 years later. Headaches were assigned to migraine or TTH at two different points in time using the International Headache Classification, ICHD-II. We used broad (definite and probable subtypes) and strict (only definite type) definitions of migraine and TTH. Results: Using the broad definition increased the reproducibility of migraine diagnosis from 48.0% to 62.0% and of TTH from 59.0% to 65.0%. A constant TTH diagnosis was related to a higher social status (OR 2.81; 95% CI 1.43-5.53) a higher level of education (OR 1.96; 95% CI 1.00-3.85) and physical inactivity (OR 2.28; 95% CI 1.16-4.49). A constant diagnosis of definite migraine was associated with severe headache (OR 2.64; 95% CI 0.97-7.21) and frequent use of headache medication (OR 4.73;). The result that coexisting TTH decreased the likelihood of a constant migraine (OR 0.29; 95% CI 0.10-0.85) is assumed to indicate response variability. Conclusions: In epidemiological studies, definite and probable subtypes should be included in the diagnosis to increase the diagnostic accuracy.

The impact of headache in Europe: principal results of the Eurolight project

“…In fact this may not be attributable to interest-bias – at least not entirely – since the country with the highest participation rate (Spain: 58.8%), and therefore least vulnerable to interest-bias, produced an even higher estimate of 35.4%. A factor is that migraine and probable migraine were combined, which has been argued to be correct in epidemiological studies provided that a diagnosis of probable migraine is trumped (as here) by a diagnosis of TTH [25,26]. On the other hand, the estimated 1-year prevalence of TTH (gender-adjusted: 38.2%) is close to the reported global mean of 42% [2], which does not suggest any large effect (if any) of questionnaire-misdiagnosis of TTH as migraine, especially since the focus on the most bothersome headache in those with two or more distinct headache types (again a pragmatic solution [26]) did mean that TTH would not always be recognized.…”

“…Thus a diagnosis of TTH trumped probable migraine [24]. In the analyses, migraine and probable migraine were considered together, as were TTH and probable TTH [25,26]. Probable MOH was assumed to be the diagnosis when headache frequency was ≥15 d/mo, duration was >4 h, the question “Do you usually take medication to treat your headaches” was answered “yes”, and frequency of acute medication use was ≥15 d/mo if the medication was simple analgesics only and ≥10 d/mo if any other (compound analgesics, opioids, triptans and/or ergots).…”

A web-based, branching logic questionnaire for the automated classification of migraine

“…This may explain, at least partially, why the sensitivity obtained for the POEM is lower than prior screening tools. While the POEM questions were designed to capture headache and associated symptoms throughout a subject's lifetime, there is evidence that headache status can change (17)(18)(19)(20)(21), and it is likely that recall of prior headache symptoms may degrade over time. Prior epidemiological studies have reported variable reproducibility in the diagnosis of migraine.…”

The methodology of population surveys of headache prevalence, burden and cost: Principles and recommendations from the Global Campaign against Headache

“…Rather, its application detracts from diagnostic accuracy [32], and it can be seen why this is so. All questionnaire-based diagnoses of primary headaches are “probable”, partly because of these uncertainties and partly, and in particular, because adequate enquiry to exclude secondary headaches cannot be undertaken.…”