The validity of questionnaire-based diagnoses: the third Nord-Trøndelag Health Study 2006–2008

Abstract

The Nord-Trøndelag Health Study (HUNT 3) performed in 2006–2008 is a replication of the cross-sectional survey from 1995 to 1997 (HUNT 2). The aim of the present study was to assess the sensitivity and specificity of questionnaire-based headache diagnoses using a personal interview by a neurologist as a gold standard. For the questionnaire-based status as headache sufferer, a sensitivity of 88%, a specificity of 86%, and a kappa statistic of 0.70 were found. Chronic headache, chronic tension-type headache (TTH), and medication overuse headache (MOH) were diagnosed with a specificity of ≥99%, and a kappa statistic of ≥0.73. Lower figures were found for the diagnoses of migraine and TTH. For individuals with headache ≥1 day per month, a sensitivity of 58% (migraine) and 96% (TTH), a specificity of 91 and 69%, and a kappa statistic of 0.54 and 0.44 were found, respectively. The specificity for migraine with aura was 95%. In conclusion, the HUNT 3-questionnaire is a valid tool for identifying headache sufferers, and diagnosing patients with chronic headache, including chronic TTH and MOH. The more moderate sensitivity for migraine and TTH makes the questionnaire-based diagnoses of migraine and TTH suboptimal for determining the prevalence. However, the high specificity of the questionnaire-based diagnosis of migraine, in particular for migraine with aura, makes the questionnaire a valid tool for diagnosing patients with migraine for genetic studies.

Paranasal sinus opacification in headache sufferers: A population-based imaging study (the HUNT study-MRI)

“…The major strengths of this study were its population-based design, the large sample size, and the use of validated headache diagnoses with good sensitivity and high specificity for both migraine and TTH (20). In the multivariate analyses, we were able to adjust for potential confounding factors.…”

“…Individuals who answered "no" to the screening question were classified as "headache free" and regarded as the reference group. The validity of these questionnaire-based diagnoses has been reported previously (20): for any headache, Hagen et al found the sensitivity to be 88% and specificity 86% (kappa value 0.70, 95% CI 0.61-0.79); for migraine, the sensitivity was 51% and specificity 95% (kappa values 0.50, 95% CI 0.32-0.68); and for TTH ≥1 days/month the sensitivity was 96% and specificity was 69% (kappa value 0.44, 95% CI 0.30-0.58).…”

Time trends in the prevalence of headache disorders. The Nord-Trøndelag Health Studies (HUNT 2 and HUNT 3)

“…For frequent headache (headache >6 days per month), and CDH (headache >14 days per month), the kappa values were 0.50, and 0.44, respectively. The validity of the year 2010 criteria were reported recently (18). For the questionnaire-based status as headache sufferer, a sensitivity of 88%, a specificity of 86%, and a kappa value of 0.70 were found for the Q2 questionnaire of HUNT 3.…”

“…Therefore, a revised version of the IHS criteria called 'liberal' migraine (Table 1) were defined to estimate the 1-year prevalence (14). In the two validation studies, acceptable agreement was found between the questionnaire-based 'liberal' migraine diagnosis and the migraine diagnosis made by clinical interview (17,18). We have also assessed 'liberal' migraine in the second 'head-HUNT', and found a small, but significant (P < 0.001), increase from 12.1% to 13.2%.…”

Pituitary Adenoma and Non-acute Headache: Is There an Association, and Does Treatment Help?

“…Current headache was defined according to the validated question from the local population based health study (HUNT): "Have you suffered from headaches during the last year?" 14,15 Acute headaches lasting less than a week before the diagnosis were excluded since pituitary apoplexy is a known cause of headache and could act as a confounder. 12,16,17 In six patients, a bleeding/apoplexy was seen on the initial MRI, making pituitary apoplexy the likely cause of the acute headache.…”