Abstract
BackgroundThe overlap between probable migraine (PM) and probable tension-type headache (PTTH) often confuses physicians in clinical practice. Although clinical decision support systems (CDSSs) have been proven to be helpful in the diagnosis of primary headaches, the existing guideline-based headache disorder CDSSs do not perform adequately due to this overlapping issue. Thus, in this study, a CDSS based on case-based reasoning (CBR) was developed in order to solve this problem.MethodsFirst, a case library consisting of 676 clinical cases, 56.95% of which had been diagnosed with PM and 43.05% of which had been diagnosed with PTTH, was constructed, screened by a three-member panel, and weighted by engineers. Next, the resulting case library was used to diagnose current cases based on their similarities to the previous cases. The test dataset was composed of an additional 222 historical cases, 76.1% of which had been diagnosed with PM and 23.9% of which had been diagnosed with PTTH. The cases that comprised the case library as well as the test dataset were actual clinical cases obtained from the International Headache Center in Chinese PLA General Hospital.ResultsThe results indicated that the PM and PTTH recall rates were equal to 97.02% and 77.78%, which were 34.31% and 16.91% higher than that of the guideline-based CDSS, respectively. Furthermore, the PM and PTTH precision rates were equal to 93.14% and 89.36%, which were7.09% and 15.68% higher than that of the guideline-based CDSS, respectively. Comparing CBR CDSS and guideline-based CDSS, the p-value of PM diagnoses was equal to 0.019, while that of PTTH diagnoses was equal to 0.002, which indicated that there was a significant difference between the two approaches.ConclusionsThe experimental results indicated that the CBR CDSS developed in this study diagnosed PM and PTTH with a high degree of accuracy and performed better than the guideline-based CDSS. This system could be used as a diagnostic tool to assist general practitioners in distinguishing PM from PTTH.
Highlights
The overlap between probable migraine (PM) and probable tension-type headache (PTTH) often confuses physicians in clinical practice
The results revealed a high degree of accuracy in recognizing most types of primary headaches; it was unable to accurately diagnose PM and PTTH when symptoms overlapped
In this study, a weighted case-based reasoning (CBR) method was applied to clinical decision support systems (CDSSs) in order to develop a CBR CDSS capable of differentiating between two types of probable primary headaches (PM and PTTH), which often confuse physicians in clinical practice
Summary
The overlap between probable migraine (PM) and probable tension-type headache (PTTH) often confuses physicians in clinical practice. Clinical decision support systems (CDSSs) have been proven to be helpful in the diagnosis of primary headaches, the existing guideline-based headache disorder CDSSs do not perform adequately due to this overlapping issue. Many migraine attacks are accompanied by tension headache-like symptoms, such as neck pain. Tension-type headaches are often accompanied by migraine headache-like symptoms, such as photophobia, phonophobia, and aggravation by routine physical activity. Among these overlaps, the overlap between probable migraine (PM) and probable tension-type headache (PTTH) is most common due to their high individual incidence rates [7-10]. Since PM and PTTH have different preventative therapies, the differential diagnosis of these two types of headaches is necessary
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