Improving the detection of chronic migraine: Development and validation of Identify Chronic Migraine (ID-CM)
Richard B. LiptonDaniel SerranoDawn C. BuseJelena PavlovićAndrew BlumenfeldDavid W. DodickSheena K. AuroraWerner J. BeckerHans‐Christoph DienerShuu‐Jiun WangMaurice VincentNada HindiyehAmaal J. StarlingPatrick GillardSepideh F. VaronMichael L. Reed
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Abstract:
Background Migraine, particularly chronic migraine (CM), is underdiagnosed and undertreated worldwide. Our objective was to develop and validate a self-administered tool (ID-CM) to identify migraine and CM. Methods ID-CM was developed in four stages. (1) Expert clinicians suggested candidate items from existing instruments and experience (Delphi Panel method). (2) Candidate items were reviewed by people with CM during cognitive debriefing interviews. (3) Items were administered to a Web panel of people with severe headache to assess psychometric properties and refine ID-CM. (4) Classification accuracy was assessed using an ICHD-3β gold-standard clinician diagnosis. Results Stages 1 and 2 identified 20 items selected for psychometric validation in stage 3 ( n = 1562). The 12 psychometrically robust items from stage 3 underwent validity testing in stage 4. A scoring algorithm applied to four symptom items (moderate/severe pain intensity, photophobia, phonophobia, nausea) accurately classified most migraine cases among 111 people (sensitivity = 83.5%, specificity = 88.5%). Augmenting this algorithm with eight items assessing headache frequency, disability, medication use, and planning disruption correctly classified most CM cases (sensitivity = 80.6%, specificity = 88.6%). Discussion ID-CM is a simple yet accurate tool that correctly classifies most individuals with migraine and CM. Further testing in other settings will also be valuable.Keywords:
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Background: Migraine is one of the most common neurological disorder and fourth most important factor for debility in human. The presentation of migraine is complex. All patients do not have same features of migraine. Objectives: The purpose of the study was to evaluate demographic and clinical patterns of headache in migraine patients. Methods: A total of 30 migraine patients who were visited in the Headache clinic, Department of Neurology, BSMMU, Dhaka were enrolled for the study. Migraine patients diagnosed according to ICHD-3 (International Classification of Headache Disorders 3rd edition) criteria. Results: Out of 30 patients mean age was 30.63±10.95 years with age range 15-60 years in migraine patients. Female were more common. Positive family history was present in 56.7% patients. Common associated symptoms were photophobia, phonophobia (96.7%) and nausea (83.3%) in migraine patients. Common precipitating factors were stress and sunlight (90%) followed by journey (80%) and insomnia (73.3%). A major portion of migraine was without aura (73.3%) and the ratio of aura to without aura is 1: 2.75. Major portion of migraine patients were complained of 4-6 attacks/ month (46.7%) which was followed by 1-3 attacks/month (36.7%). Most of the migraine patients complained as moderate headache (60%) followed by severe headache (40%). Conclusion: This study concluded that migraine is a disease of younger age group and it affects female more commonly than male, pattern of headache in migraine patients is unique. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 63-68
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Migraine headache is a common and increasing problem in the United States; it is under-recognized and under-reported. The clarification of headaches by the International Headache Society (IHS) has become the standard for the diagnosis of migraine and other headache disorders. It categorizes most migraine headaches under the following diagnosis: migraine without aura, migraine with aura, ophthalmoplegic migraine, and retinal migraine. Diagnostic criteria used to make the diagnosis of migraine include such factors as the location and character of headache pain; the extent to which pain inhibits function; the effect of physical activity on the pain; and the presence of nausea, vomiting, photophobia, or phonophobia. Proper use of the IHS classification and diagnostic criteria is important for accurate diagnosis and treatment of migraine, as well as for standardization of patients for research protocols.
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SYNOPSIS Current definitions of common migraine are not specific and new criteria are needed. Our concept of common migraine was supported by comparing the features of 100 consecutive patients we diagnosed as common migraine, with past series. The features of our patients with common migraine were then compared with 100 cases of chronic daily headache, the only form of “tension headache” that can unequivocally be differentiated from migraine. The features that occurred significantly (P<0.001) more often in patients with common migraine than in those with chronic daily headache, were nausea, vomiting, unilateral site, throbbing quality, photophobia or phonophobia, increase with menstruation, and a family history of migraine. Criteria using these features, as well as other sets of criteria, were evaluated by retrospectively applying them to the patients diagnosed as having common migraine and chronic daily headache.
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April 25, 2018April 10, 2018Free AccessFremanezumab Decreases Migraine Symptoms such as Nausea, Vomiting, Photophobia and Phonophobia and Reduces the Need for Acute Medications in the First Week of Treatment in the HFEM Study (P4.111)Marcelo Bigal, Mirna McDonald, Ernesto Aycardi, Pippa Loupe, and Robert NobleAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement) Letters to the Editor
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Background: Migraine is a most common, progressive and sometimes incapacitating disorder. Symptoms of migraine may include nausea, vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to sound) and usually a short period of visual disruption occur. Objective: To find the prevalence of migraine among headache patient in Muzaffarabad. Methods: Cross-sectional study design, 700 patients with headache were recruited in the study and measured by questionnaire “International classification of headache disorder diagnostic criteria for migraine”. Results: The Prevalence of migraine among headache patient was 40%.Conclusion: It is concluded from the results of this study, that out of 700 studyparticipants 40% (281) participants are suffering from migraine and they wereunaware of this. Keywords: Migraine, Headache
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Migraine is an episodic headache that is unilateral or bilateral, pulsating in quality, moderate to severe in intensity, and exacerbated by physical activity. Associated symptoms include nausea or vomiting, photophobia, and phonophobia. The disorder is classified as migraine with aura (previously called classic migraine) and migraine without aura (previously called common migraine), according to the presence or absence, respectively, of premonitory neurologic symptoms1.The pathophysiology of migraine is clearly related to disordered brain physiology, although neither the details nor the cause is known. The positive (stimulative) followed by negative (suppressive) neurologic symptoms of the aura and the slow spread . . .
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Background: Migraine is underdiagnosed especially by general practitioners and non-neurologists. In our experience, validated screening and diagnosing tools for migraine are generally not used outside neurology. The three-item identification of migraine (ID-Migraine™) is a short and validated screening/diagnosing tool; positive predictive value for migraine is 93% if at least two out of nausea, photophobia, or disability are present. Aim: To investigate the diagnostic yield of ID-Migraine™ when applied to the information provided in the referral letters. Methods: Retrospective analysis of 95 referral letters of patients referred for undetermined headache who were finally diagnosed with migraine at our Tertiary Care Headache Center. Results: Median age was 34 years, and 75% were women. Migraine was suspected by the referring physician in 33% of patients, whereas the remainder were classified as unclear. ID-Migraine™ criteria were fulfilled in 59% of patients with referral diagnosis of suspected migraine and 23% of patients with unclear headache, respectively. Clinical characteristics associated with migraine suspicion were photophobia and other visual symptoms. Conclusion: Applying ID-Migraine™ in primary care, emergency departments, or in specialists’ consultations outside neurology might lead to an increased frequency of migraine recognition. Knowledge about and access to those criteria should be increased, especially in the primary care setting.
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Results Retrospectively reported visual aura symptoms were variable and often overlapping; the most common symptoms were dots or flashing lights, wavy or jagged lines, blind spots, and tunnel vision. Non-visual aura symptoms were reported by approximately half of the patients, the most prevalent being numbness and tingling, followed by difficulty in recalling or speaking words. There were significant inconsistencies between the features of prospectively and retrospectively recorded attacks. Headache, nausea, photophobia, and phonophobia were all less common in prospectively recorded attacks as compared with retrospective reporting. Nausea was prospectively reported in only 51% of attacks and mostly with mild intensity. The occurrence and severity of nausea was reduced with advancing patient age. Phonophobia was not consistently reported in conjunction with photophobia. Conclusion These findings indicate variable involvement of different brain regions during migraine attacks. The variable occurrence of nausea, and of phonophobia in conjunction with photophobia may be an important factor in clinical studies where attacks are diagnosed based on these clinical features. No conflict of interest.
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The purpose of this study was to investigate the prevalence of migraine in medical students, as well as its clinical aspects and impact. All 595 medical students of Santa Casa School of Medicine of São Paulo, Brazil were asked if they had experienced any kind of headache in the past year. Those who responded positively were further investigated by an appropriate questionnaire. Diagnosis of migraine was based on the International Headache Society criteria of 1988. Forty percent of students suffered from some kind of headache; 40.2% of these headaches were migraine. The prevalence of migraine was 54.4% in women and 28.3% in men. Migraine headaches were unilateral in 24.2%, had a gradual onset in 69%, and were of a throbbing type in 88.3%. Migraine was considered incapacitating by 53.9% of students. Migraine with aura caused more disability than migraine without aura. Women experienced more intense migraine than men, and migraine with aura was especially more severe than migraine without aura. Photophobia, phonophobia, and nausea were more commonly encountered in migraine with aura. Despite the high prevalence, the high rate of disability, and the need for analgesic medication, only 7.1% of students with migraine had sought medical treatment.
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