Prevalence and Features of a Probable Diagnosis in First‐Visit Headache Patients Based on the Criteria of the Third Beta Edition of the International Classification of Headache Disorders: A Prospective, Cross‐Sectional Multicenter Study. Issue 2 (1st February 2016)

• Record Type: Journal Article
• Authors: Kim, Soo‐Kyoung; Moon, Heui‐Soo; Cha, Myong‐Jin; Kim, Byung‐Su; Kim, Byung‐Kun; Park, Jeong‐Wook; Park, Kwang‐Yeol; Sohn, Jong‐Hee; Chu, Min‐Kyung; Song, Tae‐Jin; Kim, Jae‐Moon; Cho, Soo‐Jin
• Is Part Of: Headache. Volume 56:Issue 2(2016)
• Page Start: 267
• Page End: 275
• Publication Date: 2016-02-01
• Subjects: diagnosis -- probable -- definite -- primary headache disorder -- tension‐type headache -- international classification of headache disorders -- outpatient headache clinic; Headache -- Periodicals; Headache -- Periodicals; 616.8491
• DOI: 10.1111/head.12742
• Languages: English
• ISSNs: 0017-8748

Abstract

Abstract : Objectives: This study aimed to determine the characteristics and significance of a probable diagnostic entity for primary headache disorder (PHD). Background: A diagnosis of probable primary headache disorder (PPHD) is given when a patient's headache fulfills all but one criteria of the third beta edition of the international classification of headache disorder (ICHD‐3β). Despite the uncertainty regarding this diagnosis, the inclusion of a probable diagnosis entity in this manual may aid in the accurate classification of headache disorders and allow effective treatment strategies to be started at the patient's initial visit. Methods: This cross‐sectional multicenter registry study assessed first‐visit patients with complaints of headaches who presented at the outpatient clinics of 11 neurologists in Korea. The classification of a headache disorder was made according to the criteria of the ICHD‐3 β by each investigator based on the initial evaluation of the patient or by a consensus meeting for uncertain cases. The rates of a probable diagnosis among PPHD patients were assessed and the clinical characteristics of these patients were compared with those of patients with a diagnosis of definite primary headache disorder (DPHD). Results: A total of 1429 patients were diagnosed with PHD, and 305 (21.3%) of these patients had PPHD. The proportions of PPHD differed among the subtypes of DPHD as follows: migraines (16.1%), tension‐type headaches (TTH; 33%), trigeminal autonomic cephalalgia (TAC; 40.9%), and other PHD (14%, P < .001). Patients with PPHD had less severe headache intensity than patients with DPHD (5.8 ± 2.2 vs 6.5 ± 2.1, respectively, P < .001) as well as a shorter duration of headache from onset (median: 1 vs 4 months, respectively, P < .001). The most common criteria missing for a definite diagnosis in the PPHD patients were total frequency (52.1%), duration of attack (14.4%), and accompanying symptoms (13.1%). Conclusions: A probable diagnosis was given to 21.3% of the first‐visit PHD patients due to incomplete or atypical presentations of the headaches. The incorporation of a probable diagnosis into the ICHD‐3 β may be useful for reducing the diagnoses of unspecified headaches.