Development and validation of the Asian Migraine Criteria (AMC)

Abstract

Physicians often do not use the International Classification of Headache Disorders (ICHD-II) for diagnosis of migraine in their routine clinical practice. The diagnosis of headache subtypes in 453 patients was made by headache experts according to the ICHD-II and the likelihood ratios (LR) of clinical characteristics of migraine were calculated in Part I of the study. Asian headache specialists designed the Asian Migraine Criteria (AMC) based on these LR and their experience. In Part II of the study, another group of 500 patients with headache were evaluated by a family physician, based on the AMC. Thereafter the headache experts, who were blinded to the diagnosis of these patients based on the AMC, re-evaluated them according to the ICHD-II. The AMC consists of seven items: (i) unilateral location; (ii) throbbing quality; (iii) nausea and/or vomiting; (iv) photophobia and/or sonophobia; (v) osmophobia; (vi) family history of migraine; and (vii) aura. In the AMC the presence of at least three items in adults and at least two items in children is necessary for the detection of definite migraine. The AMC had a sensitivity 99.3%, specificity 84.5%, positive predictive value (PPV) 96.9%, negative predictive value (NPV) 96.1% and validity of 96.8% for diagnosis of adult migraine compared to the ICHD-II as the gold standard. The AMC had a sensitivity 93.5%, specificity 46.8%, PPV 69.9%, NPV 86.6% and a validity of 73.4% for detection of childhood migraine against the ICHD-II. The AMC was shown to be a highly valid and reliable tool for screening of adult migraine by non-neurologists. AMC was shown to be moderately valid for detection of pediatric migraine.