The presence of four simple history features can diagnose migraine accurately

QuestionCan the clinical assessment distinguish patients with migraine from those with other types of headache?MethodsSystematic review of diagnosis studies.Data sourcesThe MEDLINE database was searched for the years 1966 to November 2005. This was supplemented by citation tracking and inspection of bibliographies of texts.Study selection and assessmentTwo authors independently assessed study eligibility, study quality, and extracted data. Studies were eligible for inclusion if they assessed diagnostic accuracy of history and physical examination tests, alone or in combination, and the reference standard was the diagnosis of a migraine-type headache made by a neurologist following the International Headache Society criteria.OutcomesDiagnostic accuracy was expressed as likelihood ratios (LR) with 95% CI.Main resultsFour eligible studies were located, two studying patients referred to headache specialists and two studying primary care patients. The two specialist studies were of very low methodological quality and there were concerns about data analysis and adequacy of the reference standard. The first primary care study was of high quality and evaluated a screening tool comprising five criteria: Pulsatile quality, duration 4–72 hOurs, Unilateral location, Nausea/vomiting, Disabling intensity (mnemonic = POUND). The presence of four or more features provided a LR of 24 (95% CI 1.5 to 388) in diagnosing definite or possible migraine and a LR of 5.8 (95% CI 2.7 to 12) for a diagnosis of definite migraine. Including the features photophobia, phonophobia, and exacerbation with the five POUND criteria algorithm did not improve diagnostic accuracy. The other primary care study was of fair quality and found that the presence of two or more of the features: disabling headache, nausea, and sensitivity to light, gave a LR+ of 3.2 (95% CI 2.7 to 3.9) and LR– of 0.25 (95% CI 0.22 to 0.28).ConclusionsA screening tool comprising five criteria: Pulsatile quality, duration 4–72 hOurs, Unilateral location, Nausea/vomiting, Disabling intensity, remembered using the mnemonic ‘POUND’, can accurately diagnose migraine