RESUMEN
BACKGROUND: Migraine affects more than 10% of the Hungarian population, causes significant disability and severely affects patients' generic and condition-specific quality of life. Despite these facts, a significant proportion of patients is not diagnosed and not treated adequately. Headache centres can provide care for only a fraction of all patients. The task of primary care providers would be greatly simplified by a reliable self-administered migraine screening questionnaire. OBJECTIVE: To develop a short and reliable questionnaire as a migraine screening tool. METHODS: Outpatients at the Headache Service, Department of Neurology, Semmelweis University completed a self-administered questionnaire which contained 9 yes/no questions about their headaches' characteristics. The number of 'yes' answers (the patients' total score) was evaluated in connection with the diagnosis based on the International Headache Society criteria. We calculated the sensitivity, specificity, positive and negative predictive value as well as the misclassification rate for each total score value and used these to establish the final cutoff value of the questionnaire. 306 patients (242 females, mean age 39.1 ± 13.3 years) were enrolled. The diagnosis was migraine in 244. RESULTS: Completing the questionnaire did not pose any difficulty for the patients. At a cutoff value of 5 points the questionnaire's sensitivity was 0.96 and specificity was 0.61. The positive predictive value was 0.91 and the negative pre- dictive value was 0.81. The misclassification rate was 0.11. DISCUSSION: Our results show that the questionnaire may help the diagnosis of migraine. In order to use it in medical practice, its further evaluation is necessary on a large representative sample of the Hungarian population.
Asunto(s)
Tamizaje Masivo/métodos , Trastornos Migrañosos/diagnóstico , Encuestas y Cuestionarios/normas , Adulto , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Calidad de Vida , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND PURPOSE: Medication overuse headache (MOH) is a common form of disabling headache presenting in as much as 30% of the patients seen in headache subspecialty practice. Quality of life (QOL) is frequently used as a secondary endpoint in headache trials. In MOH, previous trials of QOL focused mostly on generic QOL. We report the results of a pilot study that examined the feasibility of using a new QOL questionnaire, the 23-item Comprehensive Headache-related Quality of life Questionnaire (CHQQ), as an indicator of treatment response in MOH. PATIENTS AND METHODS: Fifteen patients (13 women and two men; mean age: 39.7 +/- 12.5 years) suffering from MOH were enrolled in a complex treatment programme consisting of acute medication withdrawal, preventive pharmacological treatment, structured advice and lifestyle intervention. The clinical data were collected using a detailed headache diary. CHQQ was completed before and after the treatment programme. RESULTS: MOH patients had low QOL values at baseline which was comparable to the QOL of episodic migraine patients. The treatment programme resulted in significant reductions of the number of headache days and attacks, headache severity and analgesic consumption. The dimensions and total score of CHQQ showed a significant increase after the treatment period. Seventeen of CHQQ's 23 individual items also improved significantly. CONCLUSION: In this study the new headache-specific quality of life instrument CHQQ was able to demonstrate significant improvements after adequate treatment of MOH. This result indicates that the CHQQ may be an adequate tool for assessing quality of life in headache treatment trials.