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Brief questionnaire helps screen for migraine: three simple questions.

CHICAGO -- A simple, three-question screening tool has been developed for use in primary care settings to flag patients who are likely to have migraine.

The ID Migraine screener asks patients with headache complaints these questions:

1. Has a headache limited your activities for a day or more in the last 3 months?

2. Are you nauseated or sick to your stomach when you have a headache?

3. Does light bother you when you have a headache?

Patients who answer "yes" to at least two of the questions are likely to have migraine, according to data presented at the annual meeting of the American Headache Society (AHS).

Dr. Richard B. Lipton and his colleagues at the Albert Einstein College of Medicine, New York, sought to develop a questionnaire similar to those that are used in primary care to diagnose alcoholism and depression.

They started with a nine question survey based on International Headache Society criteria; it was completed by 451 patients making primary care visits for any reason. Eligible patients either said that they wanted to talk to their physicians about their headaches or said their headaches interfered with their ability to work, study, or enjoy life. Patients were later diagnosed by headache specialists who did not know the questionnaire results.

Disability, nausea, and photophobia were the best predictors of a diagnosis of migraine, according to multivariate analysis. Of patients who answered "yes" on two of those three questions, 93% were diagnosed with migraine. Compared with diagnosis by a physician, the three question screening tool had a sensitivity of 81% and a specificity of 75% said Dr. Lipton, immediate past president of the AHS.

The questionnaire will not identify all patients with migraine. For example, some women with menstrual-related migraine are sensitive to odors, not light, and may not become nauseated as a result of migraine. Nor will the three question screening tool exclude a patient whose headaches stem from a serious underlying disease.

Dr. Lipton said that he hopes patients will be prescreened in the waiting room and given a tear sheet to give to their physician if the results of the screening tool are positive. The physician can then rule out secondary headaches and potentially confirm a diagnosis of migraine.
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Title Annotation:Clinical Rounds
Author:Norton, Patrice G.W.
Publication:Internal Medicine News
Date:Jan 1, 2004
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