One of the many difficulties in treating migraine is that many of those suffering from them don’t recognize the symptoms or seek treatment. Chronic migraine (CM) in particular is underdiagnosed and undertreated. One way to address underdiagnosis is to put an accurate self-administered tool in the hands of migraine sufferers.
This approach can be a double-edged sword, however. A self-administered tool that doesn’t have a high rate of accuracy in identifying instances of migraine could, of course, contribute to the problem of underdiagnosis.
A recent paper in Cephalalgia
reported on the development and validation of a self-administered tool, in the form of a questionnaire called ID-CM, to identify migraine and chronic CM. ID-CM was introduced at PAINWeek in September 2014, but the paper in Cephalalgia
points to its effectiveness.
To test and validate ID-CM, expert clinicians suggested candidate items from existing instruments and experience using the Delphi Panel method. (Delphi Panel is a forecasting method that sends out several rounds of questionnaires and aggregates the responses to arrive at a consensus.)
The first two stages of the testing 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%).
The tool showed promise, correctly classifying most individuals with migraine and CM. The developers of ID-CM envision the tool being used as part of a physician’s visit. “Doctors would use the information the patient reports, supplemented with information they gather, to make a diagnosis,” says paper co-author Richard B. Lipton, MD, Department of Neurology, Albert Einstein College of Medicine. “The other approach is for people with headache disorders to use [it]. In that case, my hope would be that people with headache would be motivated to seek medical [consultation] and bring their results to the doctor’s office.”
Lipton notes that the work isn’t finished. “I would like to randomize people in the neurologist’s office for headache into two groups. One group would complete ID-CM and the doctor would get the results. The other group would get usual care without ID-CM. I would hope that the use of ID-CM would improve rates of diagnosis and rates of appropriate treatment. Ultimately, we are trying to bridge a doctor-patient communication gap that leads to a diagnosis and treatment gap.”