The headache portion of the fourth Nord-Trøndelag Health Study (HUNT4) is a valid tool for identifying people with self-reported active and lifetime migraine, according to a recent study published in The Journal of Headache and Pain

Using a semistructured personal interview performed by medical doctors, study researchers set out to evaluate the “sensitivity and specificity of questionnaire-based headache diagnoses.”

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The study researchers used a population-based approach in this collaborative study between The Norwegian University of Science and Technology and the Nord-Trøndelag County Council in Norway. Between August 20, 2017, and February 28, 2019, all persons aged 20 years and older who lived in Nord-Trøndelag county received an invite to participate in the larger HUNT4 survey (N=103,800). About 54% (n=56,000) of those invited participated in the survey, and 42,600 answered initial headache questions (eg, “Have you suffered from headache during the last year?”). Of those who answered positively, 1201 received invitations to participate in the HUNT 4 subproject validation study; 232 (19.3%) participated. 

To evaluate the validity of the participants’ headache-related survey responses, neurologists and other medical doctors asked participants about headache frequency, time span, intensity, and other important features based on criteria from the International Classification of Headache Disorders (3rd Edition).

Of the questions used in the headache subproject, self-reported lifetime migraine (sensitivity 59%; specificity 99%; kappa 0.65; 95% CI, 0.55-0.75) and liberal criteria for migraine during the last year (sensitivity 64%; specificity 93%; kappa 0.58; 95% CI, 0.43-0.73) had the highest figures and best agreements.

Self-reported active migraine during the last year was also a valid agreement (sensitivity 50%; specificity 97%; kappa 0.55; 95% CI, 0.39-0.71). Restrictive migraine (based on international diagnostic criteria) occurring ≥1 day/month also showed a sound agreement between the responses and the interview (sensitivity 50%; specificity 94%; kappa 0.49; 95% CI, 0.30-0.68).

The researchers discussed a few of the study limitations, including a 2-month delay between the survey responses and the validation interviews. The researchers noted that this lag time was associated with mailed invitations and was not optimal for assessing active headache occurrences. 

According to the study researchers, although the HUNT4 questionnaire is a valid tool for self-reported lifetime and active migraine, other headache types (eg, tension headaches) only showed a fair agreement between the responses and the validation interviews. Still, they conclude by noting that “the high specificity of the questionnaire-based diagnosis of several headache types, in particular for migraine with aura, makes the questionnaire a valid tool for diagnosing patients with migraine for genetic studies.”

Hagen K, Åsberg AN, Uhlig BL, Tronvik E, Brenner E, Sand T. The HUNT4 study: the validity of questionnaire-based diagnosesJ Headache Pain. 2019;20(1):70.