Development and Validation of the Cluster Headache Screening Questionnaire

Chung, Pil-Wook; Cho, Soo-Jin; Kim, Byung-Kun; Kim, Sang-Yong; Lee, Mi Ji; Choi, Yun Ju; Park, Jeong Wook; Kim, Byung Su; Oh, Kyungmi; Moon, Heui Soo; Song, Tae Jin; Kang, Danbee; Cho, Juhee; Chung, Chin Sang

doi:10.3988/jcn.2019.15.1.90

Cited by 7 publications

(12 citation statements)

References 34 publications

(51 reference statements)

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“…A previously employed method to aid in clinical diagnoses has been the use of self-administered screening tools. In CH, tools have been developed in several languages (12)(13)(14)(15)(16)(17)(18) but selfadministered screening tools are limited in English. We performed a four year study to develop a new selfadministered screening tool in English.…”

Section: Introductionmentioning

confidence: 99%

A brief diagnostic screen for cluster headache: Creation and initial validation of the Erwin Test for Cluster Headache

et al. 2021

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Objective To use 1) newly generated data, 2) existing evidence, and 3) expert opinion to create and validate a new cluster headache screening tool. Methods In phase 1 of the study, we performed a prospective study of an English translation of an Italian screen on 95 participants (45 with cluster headache, 17 with other trigeminal autonomic cephalalgias, 30 with migraine, and 3 with trigeminal neuralgia). In phase 2, we performed a systematic review in PubMed of all studies until September 2019 with diagnostic screening tools for cluster headache. In phase 3, a 6-person panel of cluster headache patients, research coordinators, and headache specialists analyzed the data from the first two phases to generate a new diagnostic screening tool. Finally, in phase 4 this new screen was validated on participants at a single headache center (all diagnoses) and through research recruitment (trigeminal autonomic cephalalgias only, as recruitment was essential but was otherwise low). Results In total, this study included 319 unique participants including 109 cluster headache participants (95 total participants/45 cluster headache participants in phase 1, and 224 total participants/64 cluster headache participants in phase 4). It also found 123 articles on potential screening tools in our systematic review. In phase 1, analysis of the English translation of an Italian screen generated 7 questions with high sensitivity and specificity against migraine, trigeminal neuralgia, and other trigeminal autonomic cephalalgias, but had grammatical and other limitations as a general screening tool. In phase 2, the systematic review revealed nine studies that met inclusion criteria as diagnostic screening tools for cluster headache, including four where sensitivity and specificity were available for individual questions or small groups of questions. In phase 3, this data was reviewed by the expert panel to generate a brief (6-item), binary (yes/no), written screening test. In phase 4, a total of 224 participants completed the new 6-item screening test (81 migraine, 64 cluster headache, 21 other trigeminal autonomic cephalalgias, 35 secondary headaches, 7 neuralgias, 5 probable migraine, and 11 other headache disorders). Answers to the 6 items were combined in a decision tree algorithm and three items had a sensitivity of 84% (confidence interval or 95% confidence interval 73–92%), specificity of 89% (95% confidence interval 84–94%), positive predictive value of 76% (95% confidence interval 64-85%), and negative predictive value of 93% (95% confidence interval 88–97%) for the diagnosis of cluster headache. These three items focused on headache intensity, duration, and autonomic features. Conclusion The 3-item Erwin Test for Cluster Headache is a promising diagnostic screening tool for cluster headache.

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Section: Introductionmentioning

confidence: 99%

A brief diagnostic screen for cluster headache: Creation and initial validation of the Erwin Test for Cluster Headache

et al. 2021

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“…The attack duration of ≤ 3 h, which characterises CH, was coded with 1, whilst the attack duration > 3 h was coded with 0. A total score was determined by adding up the scores for the 12 items in the screening tool [34]. The total score was analysed to evaluate the overall performance of the screening tool.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple proposals have been made for screening and diagnostic tools for CH [34,52]. A screening tool with 8-items was found to have a high sensitivity (95%) and specificity (96%) in detecting CH [34]. This study, which included 42 patients with CH, of whom one patient had chronic CH, should be repeated in a higher population of patients with chronic CH to avoid selection bias [34].…”

Section: Screening Tools For Chmentioning

confidence: 99%

Section: Screening Tools For Chmentioning

confidence: 99%

“…A screening tool with 8-items was found to have a high sensitivity (95%) and specificity (96%) in detecting CH [34]. This study, which included 42 patients with CH, of whom one patient had chronic CH, should be repeated in a higher population of patients with chronic CH to avoid selection bias [34]. A lengthy 142-item web based questionnaire was tested in a large population of 437 patients with self-reported CH [52].…”

Section: Screening Tools For Chmentioning

confidence: 99%

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Development and Evaluation of a Screening Tool to Aid the Diagnosis of Cluster Headache

et al. 2020

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Cluster headache (CH), a severe primary headache, is often misdiagnosed and mismanaged. The aim of this study was to develop and evaluate a screening tool to aid the diagnosis of CH. We developed a novel 12-item screening tool. This was comprised of four components: (1) images depicting headache pain; (2) pain descriptors; (3) key questions that could differentiate between CH and migraine; and (4) a visual analogue pain scale. The total possible questionnaire score ranged from 3-32. Patients with CH and migraines (control group) were recruited prospectively from a headache centre in the North of England, UK. Two-hundred and ninety-six patients were included in the study: 81 CH patients, 36 of which suffer with episodic CH and 45 with chronic CH; 215 migraine patients, 92 of which suffer with episodic migraine and 123 with chronic migraine. The mean questionnaire score was higher in CH patients versus migraine patients (28.4 versus 19.5). At a cut-off score of >25 out of 32, the screening tool had a sensitivity of 86.4% and a specificity of 92.0% in differentiating between CH and migraine. The screening tool could be a useful instrument to aid the diagnosis of a CH. The images depicting headache pain do not clearly discriminate between CH and migraine.

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Phenotype of Cluster Headache: Clinical Variability, Persisting Pain Between Attacks, and Comorbidities—An Observational Cohort Study in 825 Patients

et al. 2021

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Introduction: Cluster headaches can occur with considerable clinical variability. The interand intra-individual variability could contribute to the fact that the clinical headache phenotype is not captured by too strict diagnostic criteria, and that the diagnosis and the effective therapy are thereby delayed. The aim of the study was to analyze the severity and extent of the clinical symptoms of episodic and chronic cluster headaches with regard to their variability and to compare them with the requirements of the International Classification of Headache Disorders 3rd edition (ICHD-3) diagnostic criteria. Methods: The study was carried out as a crosssectional analysis of 825 patients who had been diagnosed with cluster headaches by their physician. Using an online questionnaire, standardized questions on sociodemographic variables, clinical features of the cluster headache according to ICHD-3, and accompanying clinical symptoms were recorded. Results:The majority of patients with cluster headaches have clinical features that are mapped by the diagnostic criteria of ICHD-3. However, due to the variability of the symptoms, there is a significant proportion of clinical phenotypes that are not captured by the ICHD-3 criteria for cluster headaches. In addition, change in the side of the pain between the cluster episodes, pain location, as well as persisting pain between the attacks is not addressed in the ICHD-3 criteria. In the foreground of the comorbidities are psychological consequences in the form of depression, sleep disorders, and anxiety. Conclusions: The variability of the phenotype of cluster headaches can preclude some patients from receiving an appropriate diagnosis and effective therapy if the diagnostic criteria applied are too strict. The occurrence of persisting pain between attacks should also be diagnostically evaluated due to its high prevalence and severity as well as psychological strain. When treating patients with cluster headaches, accompanying psychological illnesses should carefully be taken into account.

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Development and Validation of the Cluster Headache Screening Questionnaire

Cited by 7 publications

References 34 publications

A brief diagnostic screen for cluster headache: Creation and initial validation of the Erwin Test for Cluster Headache

A brief diagnostic screen for cluster headache: Creation and initial validation of the Erwin Test for Cluster Headache

Development and Evaluation of a Screening Tool to Aid the Diagnosis of Cluster Headache

Phenotype of Cluster Headache: Clinical Variability, Persisting Pain Between Attacks, and Comorbidities—An Observational Cohort Study in 825 Patients

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