Torelli P, Beghi E, Manzoni G C
Department of Neuroscience, Headache Center, Section of Neurology, University of Parma, c/o Ospedale Maggiore, Via Gramsci 14, 43100 Parma, Italy.
Headache. 2005 Jun;45(6):644-52. doi: 10.1111/j.1526-4610.2005.05131.x.
In the absence of biological markers, the diagnosis of cluster headache (CH) rests on clinical evidence as reported through ad-hoc interviews.
The aim of this study was to validate a 16-item self-administered questionnaire designed to screen CH cases.
The questions were based on the second edition of the International Headache Society classification (ICHD-II) criteria for CH (n = 12) and on specific disease features (n = 3). Answers to each question were either "Yes,""No," or "Don't know." The validity of this screening tool was assessed using a two-step procedure. In Step 1, the 16 questions were submitted to 30 healthy subjects with different cultural backgrounds to verify content clarity. In Step 2, the questionnaire was given to 71 patients (32 women and 39 men) aged 15 to 78 years (mean 37.5 years), who were seen at the University of Parma Headache Center with a diagnosis of CH (episodic, 17; chronic, 13), migraine (without aura, 18; with aura, 3), and tension-type headache (episodic, 16; chronic, 4) according to the ICHD-II criteria. Sensitivity, specificity, and the positive and negative predictive values were calculated for each question as measures of validity.
Severity, unilaterality, and location of pain had the highest sensitivity (100%), but low (34.1%) or fairly low specificity (61.0% and 58.5%, respectively). In contrast, a positive response to lithium or verapamil had a 66.7% sensitivity and a 97.6% specificity. Sensitivity and specificity were 100% and 90.2% for duration of attacks (<180 to 240 minutes), and 90.0% and 92.7% for compulsory movements, respectively. The best discriminatory pattern for symptom detection was unilaterality of pain and the presence of at least five of the following seven features: pain severity and location, duration, frequency and daily recurrence of attacks, rhinorrhea and restlessness as accompanying symptoms.
Our findings confirm that this questionnaire is a useful method for CH screening in epidemiological studies.
在缺乏生物学标志物的情况下，丛集性头痛（CH）的诊断依赖于通过专门访谈所报告的临床证据。
本研究旨在验证一份用于筛查丛集性头痛病例的16项自填式问卷。
问题基于国际头痛协会第二版丛集性头痛分类（ICHD-II）标准（12项）以及特定疾病特征（3项）。每个问题的答案为“是”“否”或“不知道”。使用两步法评估该筛查工具的有效性。第一步，将16个问题提交给30名具有不同文化背景的健康受试者，以核实内容清晰度。第二步，将问卷发给71名年龄在15至78岁（平均37.5岁）的患者（32名女性和39名男性），这些患者在帕尔马大学头痛中心就诊，根据ICHD-II标准诊断为丛集性头痛（发作性，17例；慢性，13例）、偏头痛（无先兆，18例；有先兆，3例）和紧张型头痛（发作性，16例；慢性，4例）。计算每个问题的敏感性、特异性以及阳性和阴性预测值作为有效性指标。
疼痛的严重程度、单侧性和部位敏感性最高（100%），但特异性较低（34.1%）或相当低（分别为61.0%和58.5%）。相比之下，对锂或维拉帕米的阳性反应敏感性为66.7%，特异性为97.6%。发作持续时间（<180至240分钟）的敏感性和特异性分别为100%和90.2%，强制性动作的敏感性和特异性分别为90.0%和92.7%。症状检测的最佳判别模式是疼痛的单侧性以及以下七个特征中至少具备五个：疼痛严重程度和部位、持续时间、发作频率和每日发作情况、流涕和烦躁不安等伴随症状。
我们的研究结果证实，该问卷是流行病学研究中筛查丛集性头痛的有用方法。
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