Popular Diagnostic Measurements for Headache Lack Evidence of Accuracy – Neurology Advisor

By | June 14, 2019

There is a dearth of evidence for diagnostic accuracy in measurement scales that were reported in the literature for headache associated with musculoskeletal symptoms in adults. More studies are required to enhance the level of evidence, according to a study published in Cephalalgia.

Researchers conducted a review of literature on the diagnostic accuracy of questionnaires and other measurement instruments for musculoskeletal headaches in adults. Full-text articles where the diagnostic accuracy — expressed in sensitivity and specificity — of headache tests were included. The databases searched were PubMed (1966-2018), Cochrane (1898-2018), and Cinahl (1988-2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool and COnsensus-based Standards for the selection of health Measurement INstruments checklist for criterion validity. The Grading of Recommendations Assessment, Development and Evaluation recommendations were applied to establish the level of evidence per measurement instrument.

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Out of 3450 identified articles, 31 articles were included in the review. A total of 11 measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI, 0.85-0.89) and specificity of 0.75 (95% CI, 0.72-0.78). Of 6 questionnaires measuring migraine and tension headache that were examined, only the Headache Screening Questionnaire – Dutch version was found to have a moderate level of evidence with a sensitivity of 0.69 (95% CI, 0.55-0.8) and specificity of 0.9 (95% CI, 0.77-0.96) for migraine and a sensitivity of 0.36 (95% CI, 0.21-0.54) and specificity of 0.86 (95% CI, 0.74-0.92) for tension-type headache. For cervicogenic headache, the Cervical Flexion-Rotation test was seen to have a very low level of evidence with a pooled sensitivity of 0.83 (95% CI, 0.72-0.94) and specificity of 0.82 (95% CI, 0.73-0.91).

Limitations of this review include the comparison between reference and index tests was difficult because they were validated in different populations. The pooling of data for analysis was difficult due to variability between studies, different measurements used across cultures, the risk for bias in studies, and gaps between the diagnostic accuracy of the same measurement between studies. Researchers also recommended that the measurement instruments be validated across multiple samples of the same population to increase diagnostic certainty and that additional clinimetric properties of measurement instruments also be examined.

The investigators concluded that ID-migraine is the most studied diagnostic accuracy measurement instrument for migraine and has a moderate level of certainty; 6 measurement instruments that are examined establish the diagnostic accuracy for both migraine and tension-type headache; the Headache Screening Questionnaire has the highest level of evidence to screen for both migraine and tension-type headache; and only the Cervical Flexion Rotation Test studies the diagnostic accuracy for cervicogenic headache, but the level of evidence is very low. Also, only a few measurements reached a moderate level of evidence for diagnostic accuracy and further studies are needed to enhance the level of evidence.

van der Meer HA, Visscher CM, Vredeveld T, Nijhuis van der Sanden MWG, Engelbert RHH, Speksnijder CM. The diagnostic accuracy of headache measurement instruments: A systematic review and meta-analysis focusing on headaches associated with musculoskeletal symptoms [published online April 18, 2019]. Cephalalgia. doi: 10.1177/0333102419840777

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