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Review: history and physical examination can accurately identify migraine and the need for neuroimaging in patients with headache

Clinical impact ratings GP/FP/Primary care IM/Ambulatory care Neurology Emergency medicine

Key Words: diagnostic techniques, neurological • headache • migraine disorders

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline (to November 2005) and reference lists of primary studies, review articles, and textbooks.

Study selection and assessment: studies that assessed the usefulness of history and physical examination in predicting the diagnosis of a migraine type headache using International Headache Society criteria applied by a neurologist as the gold standard, and the presence of significant intracranial pathology in adults with non-traumatic headache using neuroimaging as the gold standard. Studies assessing patients with a specific underlying chronic disease were excluded. 4 studies of migraine (n = 1210, mean age range 39–40 y, prevalence 50–89%) and 11 studies of neuroimaging (n = 3725, mean age range 35–52 y, prevalence of abnormality 0–64%) met the selection criteria.

Outcomes: positive (+LR) and negative (–LR) likelihood ratios.

MAIN RESULTS
The 4 studies evaluating screening tests for migraine (mainly in patients without aura) used different clinical prediction rules, so the results could not be pooled. Headache . . . [Full text of this article]

Alexander W Chessman, MD, D Todd Detar, DO

Medical University of South Carolina, Charleston, South Carolina, USA

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