Validation of a Brief Self‐Administered Questionnaire for Cluster Headache Screening in a Tertiary Center

Background.— Cluster headache remains substantially underdiagnosed and undertreated. Early neurologic referral is indicated in patients with a suspected diagnosis of cluster headache (CH) so that management can be optimized and unnecessary procedures avoided. Objective.— To validate a brief self-administered questionnaire designed to screen CH cases in tertiary centers. Methods.— The review of clinical studies led us to identify the 3 more prevalent criteria of the second edition of the International Headache Society classification (International Classification of Headache Disorders, 2nd edition [ICHD II]) for all forms of CH (episodic and chronic forms). These 3 criteria were: strictly unilaterality of pain, attack duration <180 minutes if untreated, ipsilateral conjunctival injection, and/or lacrimation. These criteria were transformed in questions formulated in such a way that they could be self-administered and easily understood. Answer to each question was yes or no. Patients were unaided. The self-questionnaire was compared with the gold standard, the ICHD II criteria used by specialists at the university of Bordeaux headache center. We calculated the sensitivity and specificity for the 3 questions and for each pair of questions. Results.— The self-questionnaire was consecutively and prospectively submitted to 37 patients with CH and 59 patients with migraine. The 3-item questionnaire had a 78.4% sensibility and a 100% specificity. The 2-item questionnaire only using the attack duration associated with conjunctival injection and/or lacrimation was more sensitive (81.1%) with the same specificity (100%). Conclusions.— This 2-item questionnaire could be a useful tool for screening CH cases in tertiary centers.