Correctly Diagnosing Migraine and Chronic Migraine - The ID-CM
A primary problem with chronic migraine is that it's so underdiagnosed and undertreated. Data revealed by the American Migraine Prevalence and Prevention (AAMP) Study indicates that just 56 percent of the people in the study who met the International Headache Society (IHS) criteria for migraine had been diagnosed. Among study participants who met the modified Silberstein-Lipton chronic migraine criteria, only a startlingly low 20 percent had been diagnosed with chronic migraine.
"Migraine, particularly chronic migraine (CM), is underdiagnosed and undertreated worldwide. Our objective was to develop and validate a self-administered tool (ID-CM) to identify migraine and CM."
Developing the ID-CM was done in four stages:
- An international panel of expert clinicians working in the Delphi Panel method suggested candidate items from experience and existing instruments - ID migraine, MIDAS, Headache Impact Text (HIT-6), and the American Migraine Study (AMS)/AMPP diagnostic module. .
- Items coming out of the Delphi panel were reviewed by people with CM during cognitive debriefing interviews.
- Items were administered to a Web panel of people with severe headache to assess psychometric (dealing with the design, administration, and interpretation of tests) properties and refine ID-CM. Items with strong psychometric properties were retained; those that performed poorly were eliminated.
- Classification accuracy was assessed using an ICHD-3b gold-standard clinician diagnosis.
- Stages 1 and 2 identified 20 items selected for psychometric validation in stage 3 (n¼1562).
- The 12 psychometrically robust items from stage 3 underwent validity testing in stage 4.
- A scoring algorithm applied to four symptom items accurately classified most migraine cases among 111 study participants:
- Augmenting this algorithm with eight items assessing headache frequency, disability, medication use, and planning disruption correctly classified most CM cases.
"The simplicity and accuracy of ID-CM will enable health care professionals with or without training in neurology, pain, or headache to correctly identify the majority of patients with migraine or CM. Clinicians will then be able to accurately diagnose or refer affected patients to specialists for effective treatment that will reduce the burden of illness experienced by those with migraine and CM.."
Comments and Implications for Patients:
Due a lack of definitive laboratory tests to diagnose migraine, it is still essentially a diagnosis of exclusion. Migraine is diagnosed by looking at personal and family medical history, reviewing symptoms, conducting an examination, and ruling out other causes for the presenting symptoms. Especially in a system where doctors are taught so very little about migraine and other headache disorders in medical school, migraine is still underdiagnosed and treated.
The authors of this study, stated, "The simplicity and accuracy of ID-CM will enable health care professionals with or without training in neurology, pain, or headache to correctly identify the majority of patients with migraine or CM." The ID-CM is a welcome new tool. Hopefully, it will lead to better diagnosis and treatment for patients with migraine and chronic migraine.
More Helpful Information:
Lipton, Richard B.; Serrano, Daniel; Buse, Dawn C.; Pavlovic, Jelena M.; Blumenfield, Andrew M.; Dodick, David W.; Aurora, Sheena K.; Becker, Werner J.; Diener, Hans0Christoph; Wang, Shuu-Jiun; Bincent, Maurice B.; Hindiyeh, Nada A.; Starling, Amaal J.; Gillard, Patrick J.; Varon, Sepideh F.; Reed, Michael L. "Improving the detection of chronic migraine: Develpment and validation of Identify Chronic Migraine (ID-CM)." Cepahalalgia. 2016, Vol. 36(3) 203–215.