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The HUNT4 study: the validity of questionnaire-based diagnoses

Hagen K, Asberg AN, Uhlig BL, Tronvik E, Brenner E, Sand T

The Journal of Headache and Pain 2019 Jun 13;20(70):Epub

primary study

BACKGROUND: Questionnaire-based headache diagnoses should be validated against diagnoses made by the gold standard, which is personal interview by a headache expert. The diagnostic algorithm with the best diagnostic accuracy should be used when later analysing the data. METHODS: The Nord-Trondelag Health Study (HUNT4) was performed between 2017 and 2019. Among HUNT4 participants, a total of 232 (19.3%) out of 1,201 randomly invited were interviewed by a headache expert to assess the sensitivity, specificity and Kappa value of the questionnaire-based headache diagnoses. RESULTS: The median interval between answering the headache questions and the validation interview was 60 days (95% CI 56 to 62 days). The best agreements were found for self-reported lifetime migraine (sensitivity of 59%, specificity of 99%, and a kappa statistic of 0.65, 95% CI 0.55 to 0.75), self-reported active migraine (sensitivity of 50%, specificity of 97%, and a Kappa statistic of 0.55, 95% 0.39 to 0.71), liberal criteria of migraine (sensitivity of 64%, specificity of 93%, and a kappa statistic of 0.58, 95% CI 0.43 to 0.73) and ICDH3-based migraine >= 1 days/month (sensitivity of 50%, specificity of 94%, and a Kappa statistic of 0.49, 95% CI 0.30 to 0.68). For headache suffering >= 1 days/month a sensitivity of 90%, specificity 80%, and a kappa statistic of 0.55, 95% CI 0.41 to 0.69 were found. For tension-type headache (TTH) >= 1 days/month the agreement was 0.33 (95% CI 0.17 to 0.49). CONCLUSION: The HUNT4 questionnaire is a valid tool for identifying persons with lifetime migraine, self-reported active migraine and active migraine applying liberal modified criteria. The agreement for TTH was fair.

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