Assessment of Migraine History in Patients with a Transient Ischemic Attack or Stroke; Validation of a Migraine Screener for Stroke.
To investigate the connection between migraine and stroke, a reliable screening tool to gather information about a person's migraine history is crucial. We studied the test-characteristics of a 5-question Migraine Screener for Stroke (MISS).



We included a random sample of patients with a transient ischemic attack or stroke who answered the MISS questionnaire when they were admitted to our hospital. After discharge, a semi-structured telephone interview was conducted to validate the migraine diagnosis with the International Classification of Headache Disorders, second-edition criteria as gold standard.



Forty-nine (22.2%) of the 221 included patients were diagnosed with life-time migraine (38.5% women, 7.7% men). The sensitivity of all questions combined was 0.47 (95% CI 0.31-0.62), the specificity was 0.97 (95% CI 0.93-0.99), the positive predictive value (PPV) was 0.80 (95% CI 0.59-0.93) and the negative predictive value (NPV) was 0.87 (95% CI 0.82-0.92). One question related to the presence of headache accompanied by hypersensitivity to lights and sounds had a better sensitivity (0.96, 95% CI 0.85-1.00) and NPV (0.99, 95% CI 0.95-1.00) than all questions put together. For assessing migraine with aura, the question about visual disturbances had a good NPV (0.99, 95% CI 0.96-1.00), but a low PPV (0.38, 95% CI 0.24-0.53).



The MISS questionnaire can be used by researchers to rule out migraine history in stroke patients. To prevent misclassification, especially for the aura symptoms, patients with a positive screener should be interviewed more extensively to confirm the migraine diagnosis.
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Daphne
D
van der Willik
Nadine
N
Pelzer
Ale
A
Algra
Gisela M
GM
Terwindt
Marieke J H
MJ
Wermer
D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis*; D011795:Surveys and Questionnaires