Abstract
BackgroundChina may have the largest population of headache sufferers and therefore the most serious burden of disease worldwide. However, the rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. The use of computerized clinical decision support systems (CDSS) seems to be a better choice to solve this problem.MethodsWe developed a headache CDSS based on ICHD-3 beta and validated it in a prospective study that included 543 headache patients from the International Headache Center at the Chinese PLA General hospital, Beijing, China.ResultsWe found that the CDSS correctly recognized 159/160 (99.4%) of migraine without aura, 36/36 (100%) of migraine with aura, 20/21 (95.2%) of chronic migraine, and 37/59 (62.7%) of probable migraine. This system also correctly identified 157/180 (87.2%) of patients with tension-type headache (TTH), of which infrequent episodic TTH was diagnosed in 12/13 (92.3%), frequent episodic TTH was diagnosed in 99/101 (98.0%), chronic TTH in 18/20 (90.0%), and probable TTH in 28/46 (60.9%). The correct diagnostic rates of cluster headache and new daily persistent headache (NDPH) were 90.0% and 100%, respectively. In addition, the system recognized 32/32 (100%) of patients with medication overuse headache.ConclusionsWith high diagnostic accuracy for most of the primary and some types of secondary headaches, this system can be expected to help general practitioners at primary hospitals improve diagnostic accuracy and thereby reduce the burden of headache in China.
Highlights
China may have the largest population of headache sufferers and the most serious burden of disease worldwide
We aimed to develop a clinical decision support systems (CDSS) to help community doctors, general practitioners and inexperienced physicians to simplify clinical diagnostic procedures and increase diagnostic accuracy, in order to improve the level of diagnosis and lift the burden of headache disorders in China
These results demonstrated that the CDSS was accurate and reliable in diagnosing MO, MA, chronic migraine (CM), infrequent episodic TTH (iETTH), frequent episodic TTH (fETTH), chronic TTH (CTTH) and cluster headache (CH)
Summary
China may have the largest population of headache sufferers and the most serious burden of disease worldwide. The rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. Headache disorder is considered to be one of the most common reasons for medical consultation in both primary care units and neurological clinics [1,2]. The total burden of primary headache disorders in China is very serious, The International Classification of Headache Disorders, Second Edition (ICHD-II) [5] is available for the diagnosis of headache disorders worldwide. The relative complexity of headache subtypes and diagnostic criteria may confuse many general practitioners and even neurological physicians in primary and secondary care who are not familiar with the ICHD criteria
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