Division of Population Health Sciences 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, Gráinne Cousins, Samira Hijazze, Floris Van de Laar and Tom Fahey

Division of Population Health Sciences Outline Background and study aims Methods Results Conclusion

Division of Population Health Sciences 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

Division of Population Health Sciences 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

Division of Population Health Sciences 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

Division of Population Health Sciences 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

Division of Population Health Sciences Method Inclusion criteria: 1.Validate ID Migraine - IHS criteria as reference standard 2.Cohort or cross-sectional design 3.Sufficient data to calculate –Sensitivity –Specificity –Negative and positive predictive values –Prevalence of migraine

Division of Population Health Sciences 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

Division of Population Health Sciences 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%

Division of Population Health Sciences Results: All studies Sensitivity 95% CI Specificity 95% CI + LR 95% CI - LR 95% CI All Studies (n=13) 0.84 ( ) 0.76 ( ) 3.55 ( ) 0.21 ( ) Positive score: 59% to 84% Negative score: 59% to 23%

Division of Population Health Sciences Results: Sensitivity analysis Sensitivity 95% CI Specificity 95% CI + LR 95% CI - LR 95% CI Representative patient groups (n=6) 0.88 ( ) 0.71 ( ) 2.99 ( ) 0.17 ( ) Positive score: 60% to 82% Negative score: 60% to 21%

Division of Population Health Sciences 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

Division of Population Health Sciences Conclusions Positive score –Prescribe migraine specific medication –Monitor response to treatment Negative score –Greater certainty patient doesn’t have migraine –Consider alternative diagnosis