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. 2016 Mar;36(3):203-15.
doi: 10.1177/0333102415583982. Epub 2015 May 22.

Improving the detection of chronic migraine: Development and validation of Identify Chronic Migraine (ID-CM)

Richard B Lipton  1 , Daniel Serrano  2 , Dawn C Buse  3 , Jelena M Pavlovic  3 , Andrew M Blumenfeld  4 , David W Dodick  5 , Sheena K Aurora  6 , Werner J Becker  7 , Hans-Christoph Diener  8 , Shuu-Jiun Wang  9 , Maurice B Vincent  10 , Nada A Hindiyeh  6 , Amaal J Starling  5 , Patrick J Gillard  11 , Sepideh F Varon  11 , Michael L Reed  12
Affiliations

Improving the detection of chronic migraine: Development and validation of Identify Chronic Migraine (ID-CM)

Richard B Lipton et al. Cephalalgia. 2016 Mar.

Abstract

Background: Migraine, particularly chronic migraine (CM), is underdiagnosed and undertreated worldwide. Our objective was to develop and validate a self-administered tool (ID-CM) to identify migraine and CM.

Methods: ID-CM was developed in four stages. (1) Expert clinicians suggested candidate items from existing instruments and experience (Delphi Panel method). (2) Candidate items were reviewed by people with CM during cognitive debriefing interviews. (3) Items were administered to a Web panel of people with severe headache to assess psychometric properties and refine ID-CM. (4) Classification accuracy was assessed using an ICHD-3β gold-standard clinician diagnosis.

Results: Stages 1 and 2 identified 20 items selected for psychometric validation in stage 3 (n = 1562). The 12 psychometrically robust items from stage 3 underwent validity testing in stage 4. A scoring algorithm applied to four symptom items (moderate/severe pain intensity, photophobia, phonophobia, nausea) accurately classified most migraine cases among 111 people (sensitivity = 83.5%, specificity = 88.5%). Augmenting this algorithm with eight items assessing headache frequency, disability, medication use, and planning disruption correctly classified most CM cases (sensitivity = 80.6%, specificity = 88.6%).

Discussion: ID-CM is a simple yet accurate tool that correctly classifies most individuals with migraine and CM. Further testing in other settings will also be valuable.

Keywords: Chronic migraine; case-finding; diagnosis; migraine; screening; sensitivity; specificity; validation studies.

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Figures

Figure 1.
Figure 1.
Sampling flow. CaMEO: Chronic Migraine Epidemiology and Outcomes; RN: Research Now. *Stage 3 respondents were sent a second survey (Stage 3B) to assess test-retest reliability of the scale. Test-retest reliability and construct validity results will be presented in a forthcoming manuscript.
Figure 2.
Figure 2.
Final 12-item ID-CM tool. If both the Frequency and Symptoms boxes are checked, the patient may have chronic migraine. If the Medication Use, Activities, and Making Plans boxes are all checked, the patient may have chronic migraine. ID-CM: Identify Chronic Migraine.
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