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From the Departments of Neurology, Psychiatry, Epidemiology, and Population Health (Dr. Lipton), Albert Einstein College of Medicine, New York, NY; IMR, a Division of AdvancePCS (Dr. Kolodner), Hunt Valley, MD; Department of Neurology (Dr. Dodick), Mayo Clinic, Scottsdale, AZ; Department Family Practice/SUNY Downstate Medical Center at Brooklyn (Dr. Sadovsky), NY; New York State Psychiatric Institute (Dr. Endicott), New York; and Pfizer Inc. (Drs. Hettiarachchi and Harrison), New York, NY.
Address correspondence and reprint requests to Dr. Richard B. Lipton, Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Rousso Building, Room 332, Bronx, NY 10461; e-mail: rlipton{at}aecom.yu.edu
Background: Migraine is a highly prevalent and disabling illness that remains substantially undiagnosed in primary care. Because of the potential value of a screening tool, the current study was designed to establish the validity and reliability of a brief, self-administered migraine screener in patients with headache complaints in the primary care setting.
Methods: A total of 563 patients presenting for routine primary care appointments and reporting headaches in the past 3 months completed a self-administered migraine screener. All patients were then referred for an independent diagnostic evaluation by a headache expert, of whom 451 (80%) completed a full evaluation. Migraine diagnosis was assigned based on International Headache Society criteria after completing a semi-structured diagnostic interview.
Results: Of nine diagnostic screening questions, a three-item subset of disability, nausea, and sensitivity to light provided optimum performance, with a sensitivity of 0.81 (95% CI, 0.77 to 0.85), a specificity of 0.75 (95% CI, 0.64 to 0.84), and positive predictive value of 0.93 (95% CI, 89.9 to 95.8). Test-retest reliability was good, with a kappa of 0.68 (95% CI, 0.54 to 0.82). The sensitivity and specificity of the three-item migraine screener was similar regardless of sex, age, presence of other comorbid headaches, or previous diagnostic status.
Conclusions: The three-item ID MigraineTM migraine screener was found to be a valid and reliable screening instrument for migraine headaches. Its ease of use and operating characteristics suggest that it could significantly improve migraine recognition in primary care.
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  A. Siva, M. Zarifoglu, M. Ertas, S. Saip, H. N. Karli, B. Baykan, A. Keskinaslan, and M. Senocak Validity of the ID-Migraine screener in the workplace Neurology, April 15, 2008; 70(16): 1337 - 1345. [Abstract] [Full Text] [PDF]
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 K K Gahir and A J Larner Primary headache disorder in the emergency department: perspective from a general neurology outpatient clinic Emerg. Med. J., February 1, 2006; 23(2): 135 - 136. [Abstract] [Full Text] [PDF]
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 A. W Chessman A 3 item screening instrument had moderate sensitivity and specificity for detecting migraine headaches Evid. Based Med., March 1, 2004; 9(2): 56 - 56. [Full Text] [PDF]
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 Other articles noted: 25 Jul 03 to 7 Nov 03 Evid. Based Nurs., January 1, 2004; 7(1): e1 - 1. [Full Text] [PDF]
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