The validation of the Hungarian version of the ID-migraine questionnaire

DOI: https://doi.org/10.1186/s10194- 018- 0938- z

Abstract-Summary ID-Migraine is a short, self-administrated questionnaire, originally developed in English by Lipton and others and later validated in several languages.

Our goal was to validate the Hungarian version of the ID-Migraine Questionnaire.

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Among the 309 migraineurs, 190 patients had only migraine, and 119 patients had other headache beside migraine, namely: 111 patients had tension type head- ache, 3 patients had cluster headache, 4 patients had medication overuse headache and one patient had headache associated with sexual activity also.

Among the 380 patients, 257 had only a single type headache whereas 123

patients had multiple types of headache.

Test-retest reliability of the ID-Migraine Questionnaire was studied in 40

patients.

The validity features of the Hungarian version of the ID-Migraine question- naire were the following: sensitivity 0.95 (95% CI, 0.92–0.97), specificity 0.42 (95% CI, 0.31–0.55), positive predictive value 0.88 (95% CI, 0.84–0.91), nega- tive predictive value 0.65 (95% CI, 0.5–0.78), missclassification error 0.15 (95% CI, 0.12–0.19).

The Hungarian version of the ID-Migraine Questionnaire had adequate sensitiv- ity, positive predictive value and misclassification error, but a low specificity and somewhat low negative predictive value.

Extended: Among the 380 headache sufferers, 40 patients completed the ID-Migraine Questionnaire twice, the second time was also during a follow-up visit.

Among the 380 patients, 80% were female and 20% were male. Among the 380 patients, 257 had only one type headache, namely: 190 patients had only migraine, 44 had only TTH, 16 had only cluster headache and 7 had only other type of headache.

Among the 380 patients, 334 had a positive ID-Migraine score; 293 of them had

a clinical diagnosis of migraine.

Background This study reported 67% lifetime prevalence for any kind of headache: the one-year prevalence of migraine without aura was 7.6%, and the one-year prevalence of migraine with aura was 2%.

65% of migraine patients reported some degree of absenteeism from their work-

place or school due to their headache [266].

The most important factor is that many migraine patients—even those with quite strong headaches—do not consult their doctors because of their headache, and therefore do not receive the diagnosis of migraine [150].

The ID-Migraine indicates migraine if a patient answered “yes” at least to two of

the three screening questions.

The ID-Migraine Questionnaire was therefore found to be a valid, reliable, and easy-to-use screening instrument to detect migraine, for patients presenting in pri- mary care.

The questionnaire was successfully used for screening migraine patients in the emergency department [267], in a temporomandubular and orofacial pain clinic [268], and also in opthalamic and ear, nose and throat clinics [269].

Methods The patients also completed a 9-item Hungarian migraine screener (the MDX ques- tionnaire), developed and validated by our group [270], which was used to collect

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information about the clinical characteristics of their headaches in more detail, but was not included as a reference tool in the validation process of ID-Migraine.

The responses to the ID-Migraine Questionnaire were then compared with the clinical diagnosis of migraine: if a patient had a diagnosis of migraine, she/he was considered a migraineur regardless of having other headaches beside migraine or not. To evaluate the characteristics of the Hungarian ID-Migraine Questionnaire the receiver operating curve (ROC) was constructed among the 380 patients with differ- ent sensitivity (true positive rate) and 100-specificity (false positive rate) values according to the minimum number of positive answers to the ID-Migraine Questionnaire (0, 1, 2, and 3 positive answers).

Among the 380 headache sufferers, 40 patients completed the ID-Migraine

Questionnaire twice, the second time was also during a follow-up visit.

Results Among the 45 patients, clinically diagnosed with TTH, 23 had a positive ID-Migraine score, as did 16 of the 19 patients, whose clinical diagnosis was cluster headache.

The Hungarian version of the ID-Migraine had substantially lower specificity and NPV than the original and previous translations, we scrutinized those patients whose were diagnosed with nonmigraine headaches, especially whose ID-Migraine scores were positive, as was the case of 51% of TTH patients, 84% of cluster head- ache patients, and 29% of other headache patients, making use of the MDX ques- tionnaire that contained the clinical characteristics of their headaches in more detail. In the cluster headache group, patients with a positive ID-Migraine score had, on average, 4.0 migrainous features, compared to 0.3 in ID-Migraine negative patients. In the cluster headache group, 16 patients (15 episodic and 1 chronic) had a posi-

tive ID-Migraine score.

Discussion As outlined in the Results, 13 of the 19 chronic TTH patients with a positive ID-Migraine score could be considered migraineurs based on the characteristics of their headaches.

Our clinical experience with patients (not taking part in this study) who are fol- lowed up with a headache diary is that at least 20% of the patients who describe only migraine during the first visit would eventually be fund to have tension type headaches (TTH) as well, and a smaller percentage of patients originally diagnosed as ‘pure’ chronic TTH would also have attacks that fulfil the criteria of migraine. (This experience is not adequately reflected in the study as the number of patients included in the test-retest reliability part is still quite small.) These observations primarily affect the positive and negative predictive value and may increase the false positive test ratio, thus reducing the specificity of the questionnaire, and increasing its sensitivity and classification error.

Conclusion Our validation study proved that the Hungarian version of the ID-Migraine Questionnaire is a reliable tool to screen migraine patients in Hungary, with a high sensitivity and positive predictive value.

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Acknowledgement A machine generated summary based on the work of Csépány, Éva; Tóth, Marianna; Gyüre, Tamás; Magyar, Máté; Bozsik, György; Bereczki, Dániel; Juhász, Gabriella; Ertsey, Csaba. 2018 in The Journal of Headache and Pain.

Migraine screen questionnaire: further psychometric evidence from categorical data methods