Validated Telephone Interview Helps Classify Headache

Researchers aimed to develop and validate a telephone classification interview that nonheadache specialists could use to classify common chronic headache types in primary care.

A team of clinical headache specialists and lay individuals have developed and validated a telephone classification interview that can enable nonheadache specialists to classify headache. The interview can help identify whether chronic headaches are present and exclude individuals with symptoms suggestive of secondary causes, according to a paper published in the Journal of Headache and Pain.

A total of 26 delegates — including headache specialist neurologists, headache specialist nurses, lay representatives, and primary care providers and representatives from professional specialist interest groups and headache charity groups, all of whom resided and practiced in the United Kingdom — participated in the headache classification consensus conference. The participants discussed existing classification tools and were asked to identify key items that addressed specific questions regarding headache classification guidelines. Nurses who were trained in the logic model (n=6) performed 107 paired telephone interviews with patients from primary care. Doctors who specialized in headache performed a second validation headache classification interview.

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There was a 0.76 proportion of concordance of agreement between nurse and doctor interviews (simple κ coefficient [κ] 0.31; 95% CI, 0.09-0.52). In addition, a prevalence-adjusted, bias-adjusted κ of 0.51 was observed between nurse- and doctor-facilitated phone interviews (95% CI, 0.35-0.68). A very good agreement was found in a sensitivity test, represented by a concordance of 0.91 (κ 0.53; 95% CI, 0.28-0.79) and a prevalence-adjusted, bias-adjusted κ of 0.81 (95% CI, 0.70-0.92).

Conducting only 107 interviews may limit the generalizability of the interview across a broader patient population.

“Whilst we cannot draw any statistical inference from this study it is indicative that there is need for general practitioners to consider unrecognized cluster headache in people consulting for headaches,” the researchers wrote. “It also provides some empirical justification for the consensus decision to screen for other primary headache types.”


Potter R, Hee SW, Griffiths F, et al. Development and validation of a telephone classification interview for common chronic headache disorders. J Headache Pain. 2019;20(1):2.