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DIAGNOSTIC RAPIDE DE LA MIGRAINE

Pour Richard B. Lipton, MD, du Albert Einstein College of Medicine(New York City), malgré la forte prévalence de la migraine, son diagnostic demeure insuffisant mais demeure un diagnostic d'interrogatoire.

Sur environ 9 questions, 3 items ont été retenues comme essentielles
  • Est ce que le mal à la tête a limité vos activités pendant une journée ou plus durant les derniers 3 mois ?
  • Etes vous nauséeux ou avez vous des troubles digestifs/gastriques quand vous avez mal à la tête (Variante de la "crise de foie") ?
  • Est ce que la lumière vous gène quand vous avez mal à la tête ?
La sensibilité de ces 3 questions a été de 0,81 avec une spécficité de 0,75 et une valeur prédictive de 0,93

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Better Screening Test for Migraine CME
http://www.medscape.com/viewarticle/460305
Neurology. 2003;61:375-382
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Aug. 20, 2003

A simple screening test will likely improve the detection rate of migraine in primary care, according to the results of a validation study published in the Aug. 12 issue of Neurology. This self-administered three-question test, called ID Migraine, was as effective as a nine-question test.

"Despite the high prevalence of migraine and its associated pain and disability, diagnostic rates for migraine remain low," lead author Richard B. Lipton, MD, from the Albert Einstein College of Medicine, in New York City, says in a news release. "ID Migraine is very easy to use for both patients and doctors and we hope it will prompt patients to talk to their primary care doctor to get diagnosed and to receive treatments that will relieve their pain and improve their ability to function."

ID Migraine was validated at 27 primary care sites and 12 headache specialty practice sites in the U.S. Of 563 patients presenting for routine primary care appointments and reporting headaches in the past three months who completed the migraine screen, 451 patients (80%) completed a full independent diagnostic evaluation by a headache expert. The gold standard for migraine diagnosis was based on International Headache Society (IHS) criteria determined from a semistructured diagnostic interview.

Of nine diagnostic screening questions, a three-item subset of disability, nausea, and sensitivity to light were most effective. These questions were phrased as follows: (1) Has a headache limited your activities for a day or more in the last three months? (2) Are you nauseated or sick to your stomach when you have a headache? (3) Does light bother you when you have a headache?

Sensitivity for the three-item screen was 0.81 (95% confidence interval [CI], 0.77 - 0.85), specificity was 0.75 (95% CI, 0.64 - 0.84), positive predictive value was 0.93 (95% CI, 89.9 - 95.8), and test-retest reliability was good (kappa, 0.68; 95% CI, 0.54 - 0.82). Sex, age, presence of other comorbid headaches, and previous diagnostic status did not affect sensitivity and specificity of this screening test.

"Because patients with migraine often present in the primary care setting, the hope is that ID Migraine will help primary care doctors identify migraine quickly and easily," Dr. Lipton says. "Given the availability of effective treatment, use of the screening tool might represent an important step toward reducing the burden of this illness."

Pfizer Inc. supported this study.
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