Diagnosis and development of screening items for migraine in neurological practice in Taiwan

Background/Purpose: The objectives of this study were to: (1) survey migraine diagnoses among neurological outpatients in Taiwan; (2) compare neurologists' migraine diagnoses with the International Classification of Headache Disorders 2nd Edition (ICHD-2) criteria; and (3) evaluate the diagnostic ability of screening items on a patient migraine questionnaire. Methods: This prospective study surveyed patients who consulted neurologists for the first time with a chief complaint of headache, excluding those experiencing headaches for ≥ 15 days/month. Each neurologist interviewed a maximum of 10 patients. Patients were asked to complete a self-administered questionnaire and their physicians completed another questionnaire. The physicians were asked if patients could be diagnosed with migraine. In addition, a diagnosis of ICHD-2 migraine was made by the physician's questionnaire hrough a computer-generated algorithm. In this study, migraine without aura (code 1.1) or migraine with aura (code 1.2) were designated as "strict migraine", and the combination of strict migraine and ICHD-2 probable migraine (code 1.6) as "any migraine". Results: Among 755 patients who were eligible for analysis, 537 (71%) were diagnosed as having "any migraine", 363 (48%) with "strict migraine", and 451 (60%) with physician-diagnosed migraine. Among the 537 patients diagnosed as having "any migraine", 308 patients (57%) had not been diagnosed by any physician before. A moderate agreement (kappa statistic around 0.5) was found between the physicians' diagnoses and ICHD-2 "strict migraine" or "any migraine". In patients with ICHD-2 probable migraine (n = 174), only 52% were diagnosed with migraine by our physicians. Nausea was the best single item for predicting migraine diagnosis, while any combination of two items among nausea/vomiting, moderate or severe pain and photophobia, provided the optimum screening tool. Conclusion: Migraine was the most common headache diagnosis in the neurologists' clinics. Probable migraine was not completely adopted as a migraine spectrum among neurologists. In contrast to ID Migraine™, moderate or severe headache intensity replaced headache-related disability as one screening item for migraine in Taiwan.