Validation of The 3-Question Headache Screen in The Diagnosis of Migraine in Nigeria

BACKGROUND: Migraine is a chronic episodic disorder that is still under-diagnosed and undertreated. A rapid diagnostic method is desirable so that treatment can be initiated early. We compared the 3-question headache screen with the International Headache Society (IHS) criteria in the diagnosis of migraine among Nigerians. METHODS: Using a multi-stage sampling technique, 1513 respondents were screened for migraine using both the IHS criteria and the 3-question headache screen. A statistical comparison of the two diagnostic methods was then done by determination of kappa coefficient, sensitivity and specificity. RESULTS: The prevalence of migraine obtained using the IHS criteria was 9.6% (95% CI, 8.1%–11.1%) while it was 8.3% (95% CI, 8.1%–8.5%) with the use of the 3-question headache screen. There was a good agreement between the IHS criteria and the 3-question headache screen (k=0.68, p<0.001). The 3-question headache screen had a sensitivity of 66.2% (95% CI, 58.5%–73.9%), specificity of 97.8% (95% CI, 97.0%–98.6%), positive predictive value of 76.2% (95% CI, 68.8%–83.6%) and a negative predictive value of 96.5% (95% CI, 95.5%–97.5%). CONCLUSION: The 3-question headache screen is sensitive and specific in making a rapid diagnosis of migraine among Nigerians. Its use is thus encouraged so that appropriate management of the condition can be initiated early in order to reduce associated disability.