Stang P E, Von Korff M
Department of Applied Healthcare Research, Glaxo Inc. Research Institute, Research Triangle Park, North Carolina 27709.
Headache. 1994 Mar;34(3):138-42. doi: 10.1111/j.1526-4610.1994.hed3403138.x.
Comparison of clinical headache diagnoses in primary care to algorithm diagnoses from a standardized headache interview.
A sample of consecutive primary care headache patients (n = 779) at the Group Health Cooperative of Puget Sound were interviewed and medical records abstracted.
The medical record provided 'chart' diagnoses while a structured interview and diagnostic algorithm yielded the 'algorithm diagnosis'. The patients were also administered the depression sub-scale from the SCL 90-R, in addition to answering questions about pain intensity and disability used to grade the severity of chronic pain.
Among persons diagnosed by the primary care physician as having migraine, 78% received an algorithm diagnosis of migraine. However, study patients were more likely to receive a diagnosis of migraine by algorithm (57%) than by clinical diagnosis (33%). While clinicians infrequently recorded a diagnosis of migraine and tension-type headache in the same patients, tension-type headache was identified among half of the algorithm diagnosed migraineurs. Among patients with algorithm-diagnosed migraine, female gender, increased disability, and the presence of aura increased the likelihood that the clinician would also diagnose migraine. Conversely, the presence of tension-type headache features, high levels of depression, high number of headache days and age over 65 years reduced the likelihood of the clinician diagnosing migraine among algorithm-diagnosed cases.
The co-occurrence of migraine and tension-type headache symptoms are commonly reported by patients, however, primary care physicians usually recorded a single diagnosis of either migraine or tension headache. Among patients reporting migrainous features, the presence of chronic headache, emotional distress and the absence of disability reduced the likelihood that the clinician would assign a diagnosis of migraine. These results suggest the need for diagnostic and management strategies appropriate for patients whose headaches combine tension-type and migrainous features.
比较初级保健中临床头痛诊断与标准化头痛访谈得出的算法诊断结果。
对普吉特海湾集团健康合作社连续的初级保健头痛患者样本（n = 779）进行访谈并提取病历。
病历提供“图表”诊断，而结构化访谈和诊断算法得出“算法诊断”。除了回答用于对慢性疼痛严重程度进行分级的疼痛强度和残疾问题外，还对患者进行了SCL 90-R抑郁分量表测试。
在初级保健医生诊断为偏头痛的患者中，78%获得了偏头痛的算法诊断。然而，研究患者通过算法诊断为偏头痛的可能性（57%）高于临床诊断（33%）。虽然临床医生很少在同一患者中记录偏头痛和紧张型头痛的诊断，但在算法诊断为偏头痛的患者中有一半被识别出患有紧张型头痛。在算法诊断为偏头痛的患者中，女性、残疾增加和有先兆增加了临床医生也诊断为偏头痛的可能性。相反，存在紧张型头痛特征、高度抑郁、头痛天数多以及年龄超过65岁降低了临床医生在算法诊断病例中诊断为偏头痛的可能性。
患者普遍报告偏头痛和紧张型头痛症状同时出现，然而，初级保健医生通常只记录偏头痛或紧张性头痛其中一种诊断。在报告有偏头痛特征的患者中，存在慢性头痛、情绪困扰和无残疾降低了临床医生诊断为偏头痛的可能性。这些结果表明需要针对头痛兼具紧张型和偏头痛特征患者的诊断和管理策略。
