Accuracy of family history reports of migraine in a community-based family study of migraine.

BACKGROUND

Family history of migraine is the most potent and consistent risk factor for migraine. However, there has been limited systematic research on the reliability of family history information in detecting migraine based on valid diagnostic interviews. This study systematically evaluated the accuracy of migraine defined by the International Classification of Headache Disorders (ICHD-II) based on a direct structured interview compared to structured family history reports. The aim of the present study was to assess the validity of migraine diagnosis provided by family history compared with direct interview using a validated diagnostic interview of headache syndromes in the context of a family study of migraine comorbidity.

METHODS

The sample included 921 study participants identified in a cross-sectional community-based controlled family study of comorbidity of migraine and affective disorders recruited from the greater Washington, DC community. Lifetime migraine and tension-type headache were ascertained by direct clinical interview using a validated interview that collects ICHD-II criteria for headache syndromes. A structured history of headache was also collected from all interviewed probands and relatives regarding their relatives. All family history reports were reviewed by the study neurologist according to ICHD-II criteria. Family history ratings and diagnoses were made by the neurologist, who was blinded to the headache diagnosis obtained by direct interview.

RESULTS

The sensitivity and specificity of family history reports of migraine compared with direct interview were 38.6% and 96.8%, respectively, indicating that the false positive rate was very low, whereas the false negative rate was substantial. The positive and negative predictive values of migraine diagnosis provided by family member report are 90.0% and 67.6%, respectively.

CONCLUSIONS

Our results confirm that migraine assessed by family member report largely underestimates migraine in relatives. This demonstrates the value of direct interviews with relatives rather than reliance on family history report in both clinical practice and family and genetic studies. Potential steps to improve the reliability of family history report in clinical settings are described.