Magazine article Clinical Psychiatry News

Daily Headache Diary Improves Diagnosis

Magazine article Clinical Psychiatry News

Daily Headache Diary Improves Diagnosis

Article excerpt

FROM THE INTERNATIONAL HEADACHE CONGRESS

BERLIN - Asking patients to fill out a daily diary 1 month before their initial evaluation improves the accuracy of their headache diagnosis compared with clinical evaluation alone, according to a prospective, multicenter study.

"The basic daily headache diary was well accepted by patients and was well accepted by physicians," Dr. Rigmor Jensen said at the congress.

An earlier, pilot study with 76 patients showed the paper-based diary improved diagnostic sensitivity from 75% to 92% and specificity from 58% to 87% when combined with a clinical interview and examination (Cephalalgia 2008;28:1023- 30). The diary also provided useful data on the frequency of different types of headaches in the same patient, said Dr. Jensen, an investigator on both studies.

After this initial success, Dr. Jensen and her associates expanded their research to multiple clinical sites in Europe and South America. They randomized newly referred patients on a waiting list to two groups. They then compared 321 patients given a daily diary to complete 1 month prior to first consultation with 305 patients who received usual care (clinical evaluation and examination only).

The diary group recorded headache symptoms, medications taken, and whether their pain was unilateral or bilateral. This group provided their physicians with more complete diagnostic information. "The adequacy of the diary and clinical interview for headache diagnosis was 98% compared to 87% for the interview alone," Dr. Jensen said at the congress, which was sponsored by the International Headache Society and the American Headache Society.

The mean number or diagnoses perpatient was significantly higher in patients who kept a diary than in the usual care group (1.22 vs. 1.14). Only tension-type headache (episodic or chronic) was diagnosed more often in the usual care group than in the diary group (39% vs. …

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