Rapid and sensitive paradigm for screening patients with headache in primary care settings.
OBJECTIVE
To determine the sensitivity and specificity of a brief headache screening paradigm for primary care clinicians.


BACKGROUND
Migraine and drug rebound headache are disabling primary headache disorders. Both are underdiagnosed and undertreated. A method for rapid screening of migraine, drug rebound headache, and other daily headache syndromes would be useful. The Brief Headache Screen uses 3 questions-the frequency of severe (disabling) headache, other (mild) headache, and use of symptomatic medication-to generate diagnoses.


METHODS
The Brief Headache Screen was evaluated in an emergency department, a family practice department, and a referral headache clinic. Diagnoses from the Brief Headache Screen were compared to diagnoses of trained researchers and headache specialists.


RESULTS
Three hundred ninety-nine patients were screened and interviewed. The criterion of episodic severe (disabling) headache correctly identified migraine in 136 (93%) of 146 patients with episodic migraine and 154 (78%) of 197 patients with chronic migraine, with a specificity for any migraine (episodic or chronic) of 32 (63%) of 51. The inclusion of episodic or daily severe headache identified migraine in 100% of patients with chronic migraine. Only 6 (1.7%) of 343 patients with migraine were not identified by severe (disabling) headache. The combination of severe and mild headache frequency was sensitive to daily headache syndromes in 218 (94%) of 232 patients with a specificity of 87 (54%) of 162. Medication overuse was correctly identified in 146 (86%) of 169 patients with a specificity of 22 (79%) of 28.


CONCLUSIONS
The frequency of severe (disabling) and mild headaches and use of symptomatic medications, rapidly and sensitively screens for migraine, daily headache syndromes, and medication overuse. The use of this paradigm in primary care settings may improve the recognition of these important headache syndromes.
Maizels
Morris
M
Department of Family Practice, Kaiser Permanente, Woodland Hills, CA 91365, USA.
Burchette
Raoul
R
D002140:California; D004632:Emergency Medical Services; D020773:Headache Disorders / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018710:Pain Clinics; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires