RU2570620C1 - Screening diagnostic technique for migraine in adolescents - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: migraine signs and family medical history are identified and appraised by points: presence of aura - 1 point; headache intensity: complains of a negligible or moderate headache - 0 points; complains of a severe or debilitating headache - 3 points; headache location: frontal or temporal headache - 1 point, not localised - 0 points; unilateral headache - 2 points, bilateral headache - 0 points; character of the headache: monotonous, pressing, tightening headache - 0 points, throbbing headache - 3 points; accompanying nausea: no - 0 points, headache nausea is severe enough, so the patient cannot take food - 1 point, moderate headache nausea - 2 points, severe headache nausea - 3 points, debilitating headache nausea - 4 points; headache occurs due to physical activity: no - 0 points, mild headache - 1 point, headache increases very much - 3 points; headache worsening with bright light: no - 0 points, mild headache - 1 point, bright light annoys a lot - 2 points; the patient experiences sensitivity to noise: no - 0 points, mild headache - 1 point, noise is highly irritative - 3 points; headaches experienced by relatives: mother - 1 point, not experienced, or experienced by other relatives - 0 points. If the total score derived is 8 points or more, migraine is diagnosed in the adolescents.

EFFECT: technique enables providing more reliable screening diagnostics that is ensured by assessing the signs, which are migraine-sensitive and -specific in the adolescents.

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Description

The invention relates to medicine, namely to pediatrics and psychology, and can be used for screening diagnosis of migraine in adolescents.

A known method for assessing disabilities and daily activities of patients with migraine using the MIDAS questionnaire (Migraine Disability Assessment Scale) [Lipton R.B., Stewart W.F., Sawyer J., Edmeads J.G. Clinical utility of an instrument assessing migraine disability: The Migraine Disability Assessment (MIDAS) Questionnaire // Headache. - 2001. - No. 41. - P. 854-861]. The known method allows you to quantitatively measure the degree of influence of recurring migraine attacks on the vital activity of the patient and choose the tactics of treatment, however, it is designed only for adult patients.

There is a method of assessing the limitations of daily activity of children and adolescents due to headache according to the PedMIDAS questionnaire (Pediatric Migraine Disability Assessment Score), which is a modification of the MIDAS questionnaire for children [Hershey A.D., Powers S.W., Vockell A.L. et al. PedMIDAS: development of a questionnaire to assess disability of migraines in children. Neurology 2001; 57 (11): 2034-2039]. The PedMIDAS questionnaire contains 50 questions distributed in 3 modules. The teenager answers the questions of the questionnaire himself. The questions of the first module (36 questions) reflect the severity of headache, the nature of behavior, trauma, mood, fatigue, enthusiasm for television, computer. In answers to questions of the second module (9 questions), a teenager should note consultations with doctors of narrow specialties, the presence of chronic diseases, material conditions, the duration and intensity of headaches. In the third module (5 questions), it is necessary to assess the level of performance for headaches.

The PedMIDAS questionnaire allows you to evaluate the limitation of daily activity of adolescents due to headache and to check the response to treatment [Budchanova N.Yu. Primary headaches in schoolchildren (epidemiology, clinic, analysis of factors of their development): dissertation, medical college. sciences / N.Yu. Budchanova. - Moscow, 2008. - 158 p.], However, has the following disadvantages:

- use of an excessively long questionnaire (50 questions);

- the questionnaire includes a large number of questions to identify tension headache, and it is difficult to differentiate with migraine;

- individual questions of the questionnaire include several answer options, which creates difficulties in the diagnosis of migraine;

- the headache intensity scale is cumbersome, complicates the objectivity of answers;

- the questionnaire includes questions suggesting only a dichotomous form of answers, i.e. opposite, mutually exclusive yes or no answers. The absence of intermediate answers reduces the effectiveness of the diagnosis of migraine, especially borderline conditions, which leads to the late start of diagnostic measures to identify the causes of migraine.

There is also a method for screening diagnosis of migraine using a specially designed test "ID Migraine" [Test ID MIGRAINE. URL: http://paininfo.ru/test/migraine/]. The ID Migraine test was created with the participation of Pfizer and is a questionnaire consisting of questions that patients answer on their own. Patients need to answer “yes” or “no” to 3 questions: 1. Whether headache in the last 3 months was accompanied by nausea or vomiting; 2. Whether the headache in the last 3 months was accompanied by intolerance to light and sounds; 3. Has headache in the last 3 months limited work capacity, school or everyday activities for at least one day? If the patient answers “yes” to 2 or 3 questions of the questionnaire, the probability of migraine in him is 93%. The questionnaire is an additional tool for the diagnosis of migraine, and for an accurate diagnosis and selection of treatment, the developers of the questionnaire recommend consulting a doctor.

A well-known questionnaire has disadvantages:

- an excessively short questionnaire (3 questions) does not allow an objective diagnosis of migraine in patients;

- The questionnaire is designed for adult patients.

The closest analogue of the claimed method is a method for diagnosing headache (GB) in schoolchildren, including, in addition to the standard clinical and neurological examination, collecting complaints and anamnesis not only from the student himself, but also from his parents [N. Budchanova Primary headaches in schoolchildren (epidemiology, clinic, analysis of factors of their development): Author. diss. ... cand. honey. sciences. M., 2008, p. 7-16]. For this, a questionnaire developed by the author was used out of 44 questions relating directly to the clinical characteristics of GB, social, aggravating factors, and family and medical history factors. The disadvantage of this method is the use of an excessively long questionnaire (44 questions), intended for the differential diagnosis of primary GB in schoolchildren.

The objective of the invention is to create an informative method that provides effective screening diagnosis of migraine in adolescents without the use of laboratory data.

The task is achieved due to the fact that to identify migraines determine the signs of migraine and family history, and then evaluate them in points: the presence of an aura - 1 point; the strength of the headache: almost does not bother or bothers medium - 0 points, bothers very or very much - 3 points; localization of headache: in the forehead and temples - 1 point, no localization - 0 points; unilateral headache - 2 points, bilateral - 0 points; the nature of the headache: monotonous, oppressive, compressive - 0 points, pulsating - 3 points; nausea during a headache: no - 0 points, can not eat food - 1 point, worries about average - 2 points, strongly - 3 points, very much - 4 points; dependence of headache on physical activity: no - 0 points, a little - 1 point, very much stronger - 3 points; dependence of headache on bright light: no - 0 points, a little - 1 point, very annoying - 2 points; dependence of headache on noise: no - 0 points, a little - 1 point, very annoying - 2 points; the presence of a headache in relatives: in the mother - 1 point, in other relatives or absent - 0 points. The scores are summarized, and with a score of equal to or greater than 8 points, migraines are diagnosed in adolescents.

The method is as follows. The examined adolescents are asked to fill out a questionnaire on their own, including 10 questions reflecting the manifestations of migraine and a family history. The completed questionnaires are analyzed, the points obtained are calculated, and the presence or absence of migraine is determined by the sum of the points. If the total score is equal to or greater than 8 points, then adolescents are diagnosed with migraine.

The proposed method was examined 409 adolescents aged 12-18 years. The teenagers who completed the questionnaire were examined by a pediatric neurologist who established the following possible diagnoses in accordance with the criteria of the International Classification of Headache Disoders: Second edition (ICHD-II). Cephalagia 2004; 24; Suppl 1: 9-160]:

- lack of primary and secondary headache (104 adolescents);

- headache of tension, including “rare episodic”, “frequent episodic”, “chronic” (167 adolescents);

- migraine, including options “with aura” and “without aura” (63 teenagers);

- a combination of tension headache and migraine (55 adolescents);

- secondary headache (20 adolescents).

For all adolescents, the migraine diagnosis index (ID-M) was calculated, equal to the sum of the points scored when answering the questions of the developed questionnaire. Data on the sensitivity and specificity of the ID-M index for the diagnosis of migraine established by a neurologist at various separation points are presented in table 1.

The highest compatibility of maximum sensitivity and specificity was revealed when the ID-M separation point was 8. The ROC curve of the calculated ID-M index was plotted for clinically diagnosed migraines in the examined adolescents. The method has a sensitivity of 92% and a specificity of 79%.

Example. Teenager M., 14 years old. A survey of the teenager by the proposed method. A teenager independently filled out a questionnaire.

The total score is 12 (more than 8 points). A teenager is diagnosed with migraine.

The technical result of the method:

- the creation of an informative method that provides screening diagnosis of migraine in adolescents without the use of laboratory data;

- the objectivity of the method due to the simultaneous objective quantitative assessment of the manifestations of migraine;

- the effectiveness of the method due to: using the optimal number of questions in the questionnaire, objectively taking into account the manifestations of migraine; intermediate answers that are adapted for children and allow you to identify the intensity of symptoms of migraine; the possibility of quickly conducting a group survey (time to fill out a questionnaire is 5-10 minutes);

- high sensitivity (92%) and specificity (79%) of the method;

- expanding the arsenal of diagnostic tools for migraine in adolescents.

Using the claimed method allows timely detection of migraine in adolescents, conduct early diagnostic and therapeutic measures.

Claims (1)

A method for screening diagnostics of migraine in adolescents, including the determination of signs of migraine and a family history, characterized in that the following symptoms are determined and evaluated in points: the presence of an aura - 1 point; the strength of the headache: almost does not bother or bothers medium - 0 points, bothers very or very much - 3 points; localization of headache: in the forehead and temples - 1 point, no localization - 0 points; unilateral headache - 2 points, bilateral - 0 points; the nature of the headache: monotonous, oppressive, compressive - 0 points, pulsating - 3 points; nausea during a headache: no - 0 points, can not eat food - 1 point, worries about average - 2 points, strongly - 3 points, very much - 4 points; dependence of headache on physical activity: no - 0 points, a little - 1 point, very much stronger - 3 points; dependence of headache on bright light: no - 0 points, a little - 1 point, very annoying - 2 points; dependence of headache on noise: no - 0 points, a little - 1 point, very annoying - 2 points; the presence of a headache in relatives: in the mother - 1 point, in other relatives or not - 0 points, the points obtained are summarized, and with a total of points equal to or more than 8 points, migraines are diagnosed in adolescents.