Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

A Web-based Questionnaire to Identify Migraineurs

The Penn Online Evaluation of Migraine web-based questionnaire and its associated analysis routine identifies headache-free and individuals with migraine with good specificity, a new study found. Researchers created the branching logic questionnaire to obtain standardized headache history from a previously studied cohort. Responses were analyzed with an automated algorithm to assign individuals to 1 of several categories based on ICHD-3 criteria. The primary outcome was sensitivity and specificity for assignment of headache-free, migraine without aura, and migraine with aura labels, as compared to a prior classification by neurologist interview. Among the findings:

  • Of 118 individuals contacted, 90 (70%) completed the questionnaire; of these 31 were headache-free controls, 29 migraine without aura, and 30 migraine with aura.
  • Mean age was 41 years and 76% were female.
  • The median time to complete the questionnaire was 2.5 minutes.
  • Sensitivity of the Penn Online Evaluation of Migraine tool was 42%, 59%, 70%, and 83%, and specificity was 100%, 84%, 93%, and 90% for headache-free controls, migraine without aura, and migraine overall, respectively.

Citation:

Kaiser EA, Igdalova A, Aguirre GK, Cucchiara B. A web-based, branching logic questionnaire for the automated classification of migraine. [Published online ahead of print May 1, 2019]. Cephalalgia. doi: 10.1177/0333102419847749.

Commentary:

There is an ongoing search for a simple to use, usable online diagnostic tool for migraine diagnosis. A few tools have been very easy to use with reasonable sensitivity and specificity. For example, ID Migraine, which asks for presence or absence of photophobia, nausea, and disability has sensitivity of 0.81 and specificity of 0.75 when 2/3 are positive (Lipton et al. Neurology. 2003 Aug 12;61(3):375-82). Martin and colleagues found that nausea alone had an overall sensitivity of 81% and an overall specificity of 83% for a migraine diagnosis (Martin et al. Headache 2005;Oct;45(9):1102-12). Depending on the diagnosis, the POEM specificity reaches over 90% for migraine with aura and migraine all types, so the sophisticated approach has yielded some advance. However, the POEM had poor sensitivity for both headache freedom and migraine without aura, so more work awaits, and given the open code, the investigators encourage further ideas to improve this algorithm.

-Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH