BERLIN – Asking patients to fill out a daily diary 1 month before their initial evaluation improves the accuracy of their headache diagnosis compared with clinical evaluation alone, according to a prospective, multicenter study.
"The basic daily headache diary was well accepted by patients and was well accepted by physicians," Dr. Rigmor Jensen said at the International Headache Congress.
An earlier pilot study with 76 patients demonstrated the paper-based diary improved diagnostic sensitivity from 75% to 92% and specificity from 58% to 87% when combined with a clinical interview and examination (Cephalalgia 2008;28:1023-30). In addition, the diary provided useful data on the frequency of different types of headaches within the same patient, and patients reported that it was easy to use, said Dr. Jensen, an investigator on both studies.
Following this initial success, Dr. Jensen and her associates expanded their research to multiple clinical sites in Europe and South America. They randomized newly referred patients on a waiting list to two groups. They then compared 321 patients given a daily diary to complete 1 month prior to first consultation with 305 patients who received usual care (clinical evaluation and examination only).
Participants in the diary group recorded headache symptoms, medications taken, and whether their pain was unilateral or bilateral. This group provided their physicians with more complete diagnostic information. "The adequacy of the diary and clinical interview for headache diagnosis was 98% compared to 87% for the interview alone," Dr. Jensen said at the congress, which was sponsored by the International Headache Society and the American Headache Society.
The mean number of diagnoses per patient was significantly higher in patients who kept a diary than among those who received usual care (1.22 vs. 1.14). Only tension-type headache (episodic or chronic) was diagnosed more often in the usual care group than in the diary group (39% vs. 25%). Otherwise, there were no significant differences by headache type, said Dr. Jensen, director of the Danish headache center at Glostrup (Denmark) Hospital.
A meeting attendee asked how much additional time it takes physicians to read the diaries. "We did not record the timing," Dr. Jensen said. "But we asked the doctors, and for some it was time saving and for others it was time consuming." She added, "In my experience, the patients are prepared for questions, so it’s time saving for most of us used to using the diary. In the long run, we find it is time saving."
A total 97% of physicians reported they were satisfied with the diary. Incompleteness of some diaries and a lack of specificity for migraines with aura were among the reported problems. Dr. Jensen said a separate diary for patients who experience headache with aura is in development.
The same percentage of patients in the diary group reported satisfaction. Two patients each reported problems with understanding the questions; describing their headache intensity; the small size of the text; and the time it took to complete the daily entries. "These were not the same two patients complaining on each one," said Dr. Jensen, who also is professor of headache and neurologic pain at the University of Copenhagen.
The diary works in multiple cultures and languages. The study sites were in Italy, Denmark, Russia, Serbia, Portugal, Georgia, Germany, Chile, and Argentina.
An electronic version of the diary is in development.
Dr. Jensen said that she had no relevant financial disclosures.