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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn. Diagnostic accuracy of the ID-Migraine: a systematic review and meta-analysis Rose Galvin, Gr á inne Cousins, Samira Hijazze , Floris Van de Laar and Tom Fahey. Outline. B ackground and study aims Methods Results

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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

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  1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn Diagnostic accuracy of the ID-Migraine: a systematic review and meta-analysis Rose Galvin, GráinneCousins, Samira Hijazze , Floris Van de Laar and Tom Fahey

  2. Outline • Background and study aims • Methods • Results • Conclusion

  3. Background • Migraine is a common disorder • 18% women • 6-8% men • Despite the prevalence and burden of migraine • <50% of patients receive a medical diagnosis • 1/3 receive migraine specific prescription medications

  4. Background • Diagnosis is challenging • 1988/2004: International Headache Society (IHS) developed a comprehensive headache classification system • too cumbersome for GPs to apply • Symptom complex • unlikely any one symptom is sufficient to rule in/out condition

  5. Background • 3 item ID Migraine • brief, self-administered clinical prediction rule for adults • photophobia • nausea • Disability • Positive score if patient endorses 2 of the 3 items

  6. Study Aim Peform a comprehensive systematic review and meta-analysis of validation studies of the ID migraine to determine its diagnostic accuracy as a decision rule for identifying patients with migraine

  7. Method Inclusion criteria: • Validate ID Migraine - IHS criteria as reference standard • Cohort or cross-sectional design • Sufficient data to calculate • Sensitivity • Specificity • Negative and positive predictive values • Prevalence of migraine

  8. Method • Quality assessment (QUADAS) • Risk of spectrum bias • primary care/ headache clinic/ neurology department/ TMJ & pain clinic/ dental clinic/ ENT/ workplace/ school • Meta-analysis: Bivariate random effects model • Sensitivity analysis • Representative patient groups • Primary care; neurology departments; headache clinics

  9. Results • 11 articles (13 studies) • N=5,866 • Mean weighted prior probability of migraine - 59% • Representative patient group (6 studies) • N=3,142 • Mean weighted prior probability of migraine - 60%

  10. Results: All studies Positive score: 59% to 84% Negative score: 59% to 23%

  11. Results: Sensitivity analysis Positive score: 60% to 82% Negative score: 60% to 21%

  12. Conclusions • Useful tool to rule out migraine • Sensitivity analysis • Support generalisability of overall study findings • Limitations • Gender differences unclear • High pre-test probability in included studies

  13. Conclusions • Positive score • Prescribe migraine specific medication • Monitor response to treatment • Negative score • Greater certainty patient doesn’t have migraine • Consider alternative diagnosis

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