Maizels Morris, Wolfe William J
Kaiser Permanente--Family Medicine, Woodland Hills, CA 91365-4084, USA.
Headache. 2008 Jan;48(1):72-8. doi: 10.1111/j.1526-4610.2007.00918.x. Epub 2007 Sep 12.
Migraine is a highly prevalent chronic disorder associated with significant morbidity. Chronic daily headache syndromes, while less common, are less likely to be recognized, and impair quality of life to an even greater extent than episodic migraine. A variety of screening and diagnostic tools for migraine have been proposed and studied. Few investigators have developed and evaluated computerized programs to diagnose headache.
To develop and determine the accuracy and utility of a computerized headache assessment tool (CHAT). CHAT was designed to identify all of the major primary headache disorders, distinguish daily from episodic types, and recognize medication overuse.
CHAT was developed using an expert systems approach to headache diagnosis, with initial branch points determined by headache frequency and duration. Appropriate clinical criteria are presented relevant to brief and longer-lasting headaches. CHAT was posted on a web site using Microsoft active server pages and a SQL-server database server. A convenience sample of patients who presented to the adult urgent care department with headache, and patients in a family practice waiting room, were solicited to participate. Those who completed the on-line questionnaire were contacted for a diagnostic interview.
One hundred thirty-five patients completed CHAT and 117 completed a diagnostic interview. CHAT correctly identified 35/35 (100%) patients with episodic migraine and 42/49 (85.7%) of patients with transformed migraine. CHAT also correctly identified 11/11 patients with chronic tension-type headache, 2/2 with episodic tension-type headache, and 1/1 with episodic cluster headache. Medication overuse was correctly recognized in 43/52 (82.7%). The most common misdiagnoses by CHAT were seen in patients with transformed migraine or new daily persistent headache. Fifty patients were referred to their primary care physician and 62 to the headache clinic. Of 29 patients referred to the PCP with a confirmed diagnosis of migraine, 25 made a follow-up appointment, the PCP diagnosed migraine in 19, and initiated migraine-specific therapy or prophylaxis in 17.
The described expert system displays high diagnostic accuracy for migraine and other primary headache disorders, including daily headache syndromes and medication overuse. As part of a disease management program, CHAT led to patients receiving appropriate diagnoses and therapy. Limitations of the system include patient willingness to utilize the program, introducing such a process into the culture of medical care, and the difficult distinction of transformed migraine.
偏头痛是一种高度流行的慢性疾病，伴有显著的发病率。慢性每日头痛综合征虽不太常见，但较难识别，且比发作性偏头痛对生活质量的损害更大。已提出并研究了多种用于偏头痛的筛查和诊断工具。很少有研究者开发并评估用于诊断头痛的计算机程序。
开发并确定一种计算机化头痛评估工具（CHAT）的准确性和实用性。CHAT旨在识别所有主要的原发性头痛疾病，区分每日发作型和发作性类型，并识别药物过度使用情况。
CHAT采用专家系统方法进行头痛诊断，初始分支点由头痛频率和持续时间确定。给出了与短暂性和持续性头痛相关的适当临床标准。CHAT使用微软活动服务器页面和SQL服务器数据库服务器发布在网站上。邀请了到成人急诊部就诊的头痛患者以及家庭医疗候诊室的患者作为便利样本参与。完成在线问卷的患者被联系进行诊断访谈。
13５名患者完成了CHAT，117名完成了诊断访谈。CHAT正确识别出35/35（100%）例发作性偏头痛患者和42/49（85.7%）例转化型偏头痛患者。CHAT还正确识别出11/11例慢性紧张型头痛患者、2/2例发作性紧张型头痛患者和1/1例发作性丛集性头痛患者。药物过度使用在43/52（82.7%）的病例中被正确识别。CHAT最常见的误诊见于转化型偏头痛或新的每日持续性头痛患者。50名患者被转诊至其初级保健医生处，62名被转诊至头痛诊所。在被转诊至初级保健医生处且确诊为偏头痛的29名患者中，25名进行了随访预约，初级保健医生诊断出19例偏头痛，并对17例启动了偏头痛特异性治疗或预防措施。
所描述的专家系统对偏头痛和其他原发性头痛疾病，包括每日头痛综合征和药物过度使用，显示出较高的诊断准确性。作为疾病管理计划 的一部分，CHAT使患者得到了适当的诊断和治疗。该系统的局限性包括患者使用该程序的意愿、将这样一个过程引入医疗文化以及转化型偏头痛的鉴别困难。
