Development and Evaluation of a Screening Tool to Aid the Diagnosis of a Cluster Headache.

Alina Buture,Chao Huang,Jason W Boland,Fayyaz Ahmed,Lisa Dikomitis

doi:10.3390/brainsci10020077

Alina Buture, Chao Huang + Show 3 more

Open Access

https://doi.org/10.3390/brainsci10020077

Copy DOI

Abstract

Cluster headache (CH), a severe primary headache, is often misdiagnosed and mismanaged. The aim of this study was to develop and evaluate a screening tool to aid the diagnosis of CH. We developed a novel 12-item screening tool. This was comprised of four components: (1) images depicting headache pain; (2) pain descriptors; (3) key questions that could differentiate between CH and migraine; and (4) a visual analogue pain scale. The total possible questionnaire score ranged from 3-32. Patients with CH and migraines (control group) were recruited prospectively from a headache centre in the North of England, UK. Two-hundred and ninety-six patients were included in the study: 81 CH patients, 36 of which suffer with episodic CH and 45 with chronic CH; 215 migraine patients, 92 of which suffer with episodic migraine and 123 with chronic migraine. The mean questionnaire score was higher in CH patients versus migraine patients (28.4 versus 19.5). At a cut-off score of >25 out of 32, the screening tool had a sensitivity of 86.4% and a specificity of 92.0% in differentiating between CH and migraine. The screening tool could be a useful instrument to aid the diagnosis of a CH. The images depicting headache pain do not clearly discriminate between CH and migraine.

Highlights

A cluster headache (CH) is a severe primary headache with a prevalence of approximately 0.1% [1].CH patients incur a high healthcare cost, estimated in the USA as greater than $2.8 billion/year [2].CH is characterised by trigeminal distribution of pain, cranial autonomic symptoms and circadian and circannual periodicity [3]
Two-hundred and ninety-six patients were included in the study: 81 CH patients, 36 of which suffer with episodic CH and 45 with chronic CH; 215 migraine patients, 92 of which suffer with episodic migraine and 123 with chronic migraine
Patients older than 18 who received a prior diagnosis of CH or migraine based on the International Classification of Headache Disorders-3b (ICHD-3b) criteria [23] were invited to participate by A.B. and F.A

Summary

Introduction

A cluster headache (CH) is a severe primary headache with a prevalence of approximately 0.1% [1].CH patients incur a high healthcare cost, estimated in the USA as greater than $2.8 billion/year [2].CH is characterised by trigeminal distribution of pain, cranial autonomic symptoms and circadian and circannual periodicity [3]. CH has very distinct clinical features, patients often face delay in diagnosis, misdiagnosis, and mismanagement [6,8,9,10,11]. Misdiagnosis could be avoided if healthcare professionals (such as primary care practitioners, clinicians in secondary and emergency care) are aware of the striking differences between the clinical presentation of CH and that of migraine. Despite the significant disability and impact on quality of life associated with CH, patients are often in a diagnostic limbo for many years, living with debilitating, severely painful attacks, before a correct diagnosis is made [13]. A correct and timely diagnosis will improve the quality of life, will avoid unnecessary consultations and referrals, and, as a consequence, will reduce the financial and human health resource burden on the healthcare system [13].

Objectives

Methods

Results

Conclusion