The Reliability of an Instrument Used to Evaluate Primary Headaches

Nelson CProceedings of the Int’l Conference of Spinal Manipulation1993: 63

Background and Objectives: By convention and tradition, primary those not caused by infectious, neoplastic, or vascular lesions, have been diagnosed as being either a tension type headache or a migraine headache or one of the variants of those two types. There is a mounting body of evidence that rather than existing as discrete pathophysiologic entities, these chronic headaches are better understood as existing on a continuum; at one end of the continuum lies a pure migraine headache and at the other end lies a pure tension headache. Most chronic headaches exhibit clinical qualities of both tension and migraine headaches. Additionally, there is evidence that these headaches share common etiologies. An instrument has been developed that attempts to establish where on this continuum a particular headache lies and the reliability of this instrument will be evaluated. Means of measuring the validity of this instrument will also be discussed.

Methods: Patients meeting the following criteria were accepted into this study: 1. Patient has had headaches for at least one year. 2. Patient has at least four headaches per month or, if fewer than four headaches per month, rates those headaches as severe. 3. Patient is not currently being treated for headaches. Patients meeting these criteria were administered the instrument. They were told only that we were collecting information about headaches. One month later the instrument was re-administered to the patients. They were told that this was a questionnaire similar to the one they filled out before. it was, in fact, the identical questionnaire. Two different sets of patients participated in this study. One group consisted of patients diagnosed as having migraine headaches who were enrolled in a controlled clinical trial comparing chiropractic to medical therapy. The questionnaire was administered before any treatment was initiated. The second group consisted of students who met the criteria and whose headaches were undiagnosed.

Results: Data collection and analysis are ongoing. The results will be evaluated for test-retest reliability and for internal consistency.

Conclusions: By identifying where on the headache continuum a particular headache lies, a clinician can make a more informed decision regarding treatment and prognosis of that patient.

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