Validation of a Brief Nurse-Administered Migraine Assessment Tool

Authors

  • Dawn A. Marcus MD,

    1. Departments of Anesthesiology and Critical Care Medicine (Drs. Marcus and Rudy), Otolaryngology (Nurse Kapelewski and Drs. Jacob and Furman), Psychiatry (Drs. Jacob and Rudy), and Biostatistics (Dr. Rudy), University of Pittsburgh (Pa) School of Medicine.
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  • Cindy Kapelewski RN,

    1. Departments of Anesthesiology and Critical Care Medicine (Drs. Marcus and Rudy), Otolaryngology (Nurse Kapelewski and Drs. Jacob and Furman), Psychiatry (Drs. Jacob and Rudy), and Biostatistics (Dr. Rudy), University of Pittsburgh (Pa) School of Medicine.
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  • Rolf G. Jacob MD,

    1. Departments of Anesthesiology and Critical Care Medicine (Drs. Marcus and Rudy), Otolaryngology (Nurse Kapelewski and Drs. Jacob and Furman), Psychiatry (Drs. Jacob and Rudy), and Biostatistics (Dr. Rudy), University of Pittsburgh (Pa) School of Medicine.
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  • Thomas E. Rudy PhD,

    1. Departments of Anesthesiology and Critical Care Medicine (Drs. Marcus and Rudy), Otolaryngology (Nurse Kapelewski and Drs. Jacob and Furman), Psychiatry (Drs. Jacob and Rudy), and Biostatistics (Dr. Rudy), University of Pittsburgh (Pa) School of Medicine.
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  • Joseph M. Furman MD, PhD

    1. Departments of Anesthesiology and Critical Care Medicine (Drs. Marcus and Rudy), Otolaryngology (Nurse Kapelewski and Drs. Jacob and Furman), Psychiatry (Drs. Jacob and Rudy), and Biostatistics (Dr. Rudy), University of Pittsburgh (Pa) School of Medicine.
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Address all correspondence to Dr. Dawn A. Marcus, Pain Evaluation and Treatment Institute, 5750 Centre Avenue, Pittsburgh, PA 15206.

Abstract

Objective.—To validate a brief tool for screening migraine.

Background.—Migraine is a common, but underdiagnosed condition. Effective utilization of nonphysician personnel to reliably screen patients for migraine may improve identification of migraineurs for clinical treatment and research.

Methods.—An 8-question Migraine Assessment Tool (based on International Headache Society criteria) was designed for administration by a nurse with no specialized headache training as a pre-assessment for the diagnosis of migraine for use in either a research or clinical environment. A community sample of 80 adults (71 women, 9 men; mean age, 33.7 years; 80% white, 14% African American, 2.5% Asian American) with self-reported headache was recruited through advertisements. A headache specialist independently diagnosed subjects using clinical assessment, and a nurse who works in a balance disorder clinic used the Migraine Assessment Tool. Agreement between physician and nurse-administered Migraine Assessment Tool diagnoses was determined. Each subject returned in 2 to 4 weeks for a second assessment, administered by the same nurse. Agreement between the 2 diagnoses from the Migraine Assessment Tool was calculated.

Results.—Comparison between diagnosis by the physician versus the Migraine Assessment Tool revealed a positive predictive value of 0.85; negative predictive value, 0.84; sensitivity, 0.89; specificity, 0.79; and observed agreement, 0.85. Cohen's kappa reliability measure was 0.69, indicating good test reliability. Interestingly, in 8 of the 12 cases of disagreement, the examiner diagnosing nonmigraine diagnosed analgesic overuse headache. Comparing diagnoses assigned by the 2 separate administrations of the Migraine Assessment Tool revealed a Cohen's kappa of 0.69. Notably, 9 of the 12 cases of nonagreement on the 2 assessments were due to subjects endorsing analgesic overuse in only 1 of the 2 testing sessions.

Conclusions.—This study showed good reliability and stability of a new, brief, nurse-administered migraine questionnaire. In addition, the study also showed that consistency in self-reporting analgesic overuse within individuals with headache is poor. This suggests the need for repeat questioning about analgesic overuse on subsequent appointments to ensure absence of analgesic overuse headache.

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