Diagnosing Chronic Migraines 2015-05-24

Chronic migraine is substantially underdiagnosed.

"An accurate diagnosis is challenging for many physicians and a tool to help make that diagnosis would be welcomed," said Dr. Webster.

Some new diagnostic criteria (ID-CM) have been produced in an attempt to increase diagnostic rates. Unfortunately only one drug has been approved for chronic migraine...

Developing the tool took almost 3 years and involved a rigorous multistep process. The research team reviewed existing instruments, sought input and consensus from headache physicians and research scientists from around the world, and had a group of people with CM assess the relevance of the questions being developed.

Another important step in the development process was psychometric validation. "This is where we look at someone with chronic migraine, someone with episodic migraine, and someone with no headache and see how well a particular item (for example, whether the pain is pulsating or how often the pain is severe) identifies or separates the different groups," explained Dr. Buse.

Check out the attached file for more. Here are the criteria:

ID-CM Questions

• How often was the pain moderate or severe?
• How often were you unusually sensitive to light (eg, you felt more comfortable in a dark place)?
• How often were you unusually sensitive to sound (eg, you felt more comfortable in a quiet place)?
• How often did you feel nauseated or sick to your stomach?
• In the last month (past 30 days), how often did your headaches interfere with making plans?
• In the last month (past 30 days), how often did you worry about making plans because of your headaches?
• In the last month (past 30 days), on how many days did you miss work or school because of your headaches?
• In the last month (past 30 days), on how many days did you miss family, social, or leisure
• activities because of your headaches?
• In the last month (past 30 days), on how many days did you have a headache of any type?
• In the last 3 months (past 90 days), on how many days did you have a headache of any type?
• If a headache lasted more than 1 day, count each day.
• In the last month (past 30 days), on how many days did you use over-the-counter medications to treat your headache attacks?
• In the last month (past 30 days), on how many days did you use prescription medications to treat

Preliminary Scoring - You Meet the Criteria for Chronic Migraine If You

• Report moderate to severe pain intensity with either photophobia and phonophobia and nausea
• and have headaches about every other day

or

• Report at least a third of your activity days on at least one of three disability items (???)
• and use prescription meds to reduce your headaches on at least 10 days a month
• and report that headaches reduce your planning half the time or more for 2/3rds of "making plans" item (???)