A self-administered screener for migraine in primary care: The ID Migraine validation study.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Lipton
R B
RB
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. rlipton@aecom.yu.edu
Dodick
D
D
Sadovsky
R
R
Kolodner
K
K
Endicott
J
J
Hettiarachchi
J
J
Harrison
W
W
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis*; D010358:Patient Participation / Q000379:methods*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*; D014481:United States