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Quantifying headache symptoms and other headache features from chart notes.
Lora A Hasse1, P Neal Ritchey, Robert Smith
1Department of Family Medicine, College of Medicine, University of Cincinnati, OH 45221-0378, USA.
Headache
|September 28, 2004
Summary
A new method estimates that nearly 3 in 10 patients diagnosed with headache not otherwise specified (NOS) may actually have migraine or probable migraine headache. This highlights potential underdiagnosis in primary care settings.
Area of Science:
- Neurology
- Primary Care Medicine
- Health Informatics
Background:
- Headache is a prevalent symptom encountered in family practice.
- Many patients with headache do not receive specific diagnoses.
Purpose of the Study:
- To develop a method for quantifying headache features in primary care charts.
- To assess the prevalence of migraine or probable migraine among patients diagnosed with headache not otherwise specified (NOS).
Main Methods:
- Reviewed 454 patient charts with headache NOS diagnoses.
- Developed a template with 20 headache items based on International Headache Society criteria.
- Applied decision rules to reclassify NOS headaches into migraine, probable migraine, or other categories.
Main Results:
- An estimated 29% of headache NOS patients were reclassified as migraine (8%) or probable migraine (21%).
- Migraine reclassifications averaged 6.5 symptoms; probable migraine averaged 4.7 symptoms.
- The classification model demonstrated 96% predictive accuracy.
Conclusions:
- A significant proportion of migraine and probable migraine cases may be missed in general practice.
- The developed method can aid in creating better diagnostic tools for non-specialists.
- Findings aim to improve the standard of care for primary care headache patients.