Pryse-Phillips William, Aubé Michel, Gawel Marek, Nelson Robert, Purdy Allan, Wilson Keith
Memorial University of Newfoundland, St. John's Newfoundland, Canada.
Headache. 2002 Sep;42(8):728-37. doi: 10.1046/j.1526-4610.2002.02174.x.
Despite the availability of objective criteria, the diagnosis of migraine is thought to be missed frequently in primary practice.
To determine the most important questions assisting in the clinical diagnosis of migraine headache.
A cohort of 461 patients referred to headache specialists in Canada was assessed using a pro-forma questionnaire that was completed by the patients alone or administered by the physicians themselves. A final clinical diagnosis was recorded after a complete clinical evaluation. In a subsequent validation study, three questions derived from the results of the first phase of the study were administered to a new cohort of 128 patients, and diagnoses of "migraine" or "not migraine" were recorded according to the decision generated in the first part of the study. The final clinical diagnosis was taken as the "gold standard" for diagnosis, and the results from the two independently derived diagnostic methods were compared.
Statistical analysis of the responses from part 1 of the study yielded three questions (related to daily occurrence, unilaterally, and functional impairment) that distinguished between pure migraine and other headache diagnoses with high reliability and validity. The sensitivity and selectivity of the three-question protocol exceeded 91%.
The use of three questions related to headache frequency, laterality, and impact on functioning may represent an attractive screening instrument in primary care practice, alerting physicians to the diagnosis of migraine in patients or to the possibility of a second or alternative headache diagnosis in patients in whom their diagnosis of migraine previously has been made. The presence of multiple headache syndromes in individual patients, as is common in tertiary referral practice, may reduce the discriminating power of the three-question protocol.
尽管有客观标准，但偏头痛的诊断在初级医疗实践中常被漏诊。
确定有助于偏头痛性头痛临床诊断的最重要问题。
使用预填问卷对461名转诊至加拿大头痛专科医生处的患者进行评估，问卷由患者单独完成或由医生亲自填写。经过全面临床评估后记录最终临床诊断。在后续验证研究中，将从第一阶段研究结果中得出的三个问题应用于128名新患者组成的队列，并根据第一部分研究得出的判断记录“偏头痛”或“非偏头痛”的诊断。将最终临床诊断作为诊断的“金标准”，并比较两种独立得出的诊断方法的结果。
对研究第一部分的回答进行统计分析得出三个问题（与每日发作情况、单侧性和功能损害有关），这些问题能够以高可靠性和有效性区分单纯偏头痛与其他头痛诊断。三问题方案的敏感性和选择性超过91%。
使用与头痛频率、单侧性及对功能的影响相关的三个问题，可能是初级医疗实践中一种有吸引力的筛查工具，提醒医生对患者进行偏头痛诊断，或对先前已诊断为偏头痛的患者进行二次或其他头痛诊断。在三级转诊实践中常见的个体患者存在多种头痛综合征的情况，可能会降低三问题方案的鉴别能力。
