Use of cluster analysis to validate IHS diagnostic criteria for migraine and tension-type headache.
Cluster analysis was used to validate headache diagnostic criteria of the International Headache Society (IHS). Structured diagnostic interviews were conducted on 443 headache sufferers from a community sample, which was randomly split to allow replication. Hierarchical cluster analysis of symptoms in both subsamples revealed two distinct (P<.001) clusters: (1) unilateral pulsating pain, pain aggravated by activity, and photophobia and phonophobia, and (2) bilateral pressing/tightening pain, mild to moderate intensity, and absence of nausea/vomiting. These clusters were consistent with IHS migraine and tension-type classifications, respectively. Replication using a non-hierarchical clustering technique, k-means cluster analysis, revealed a migrainelike patient cluster, reflecting more frequent pulsating, unilateral pain; more severe pain; and pain aggravated by activity; nausea, vomiting, photophobia, and phonophobia. A tensionlike patient cluster was also identified, reflecting more frequent pressing/tightening pain, mild to moderate pain, bilateral location, and absence of nausea/vomiting. These patient clusters were consistent across subsamples. International Headache Society diagnoses corresponded with classification based upon statistically derived clusters (P<.001). These results indicate that headache symptoms cluster empirically in a manner consistent with IHS criteria for migraine and tension-type headaches. Criterion overlap problems regarding pain intensity and duration were identified. Overall, these data support migraine and tension-type headache as distinct entities, and provide support for the IHS diagnostic criteria with minor modifications.
Bruehl
S
S
Center for Pain Studies, Rehabilitation Institute of Chicago, Ill 60611, USA.
Lofland
K R
KR
Semenchuk
E M
EM
Rokicki
L A
LA
Penzien
D B
DB
D000328:Adult; D016000:Cluster Analysis; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D012001:Hyperacusis / Q000209:etiology; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D009325:Nausea / Q000209:etiology; D020795:Photophobia / Q000209:etiology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012955:Societies, Medical; D018781:Tension-Type Headache / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D014839:Vomiting / Q000209:etiology