㈵−５ |
一般医は頭痛医療にどう取り組むべきか |
論文抄録 |
OBJECTIVE: To determine the sensitivity and specificity of a brief headache screening paradigm for primary care clinicians. BACKGROUND: Migraine and drug rebound headache are disabling primary headache disorders. Both are underdiagnosed and undertreated. A method for rapid screening of migraine, drug rebound headache, and other daily headache syndromes would be useful. The Brief Headache Screen uses 3 questions-the frequency of severe (disabling) headache, other (mild) headache, and use of symptomatic medication-to generate diagnoses. METHODS: The Brief Headache Screen was evaluated in an emergency department, a family practice department, and a referral headache clinic. Diagnoses from the Brief Headache Screen were compared to diagnoses of trained researchers and headache specialists. RESULTS: Three hundred ninety-nine patients were screened and interviewed. The criterion of episodic severe (disabling) headache correctly identified migraine in 136 (93%) of 146 patients with episodic migraine and 154 (78%) of 197 patients with chronic migraine, with a specificity for any migraine (episodic or chronic) of 32 (63%) of 51. The inclusion of episodic or daily severe headache identified migraine in 100% of patients with chronic migraine. Only 6 (1.7%) of 343 patients with migraine were not identified by severe (disabling) headache. The combination of severe and mild headache frequency was sensitive to daily headache syndromes in 218 (94%) of 232 patients with a specificity of 87 (54%) of 162. Medication overuse was correctly identified in 146 (86%) of 169 patients with a specificity of 22 (79%) of 28. CONCLUSIONS: The frequency of severe (disabling) and mild headaches and use of symptomatic medications, rapidly and sensitively screens for migraine, daily headache syndromes, and medication overuse. The use of this paradigm in primary care settings may improve the recognition of these important headache syndromes. |
文献 PubMed−ID |
PMID: 12752748 |
エビデンスレベル |
N/A |
文献タイトル (日本語) |
プライマリーケアーにおける頭痛スクリーニングのパラダイム |
目的 |
プライマリーケアー医に片頭痛診断のパラダイムの感度と特異性を確定 |
研究期間 |
不明 |
結果 |
重症な頭痛と軽度頭痛の出現頻度，内服薬の使用について質問する簡易スクリーニングをつくり専門医の診断と比較する． これらにより片頭痛の特異度は６３％．特異連日出現する重度な頭痛の 93 ％が片頭痛と診断された．重度と軽度の頭痛の組み合わせでの出現は daily headache で特異度は 54% であった．薬物乱用頭痛は特異度が 79% であった． |
結論 |
これらのスクリーニングは頭痛の診断に有効． |
作成者 |
濱田潤一， 清水利彦 |
論文抄録 |
BACKGROUND: Migraine is a highly prevalent and disabling illness that remains substantially undiagnosed in primary care. Because of the potential value of a screening tool, the current study was designed to establish the validity and reliability of a brief, self-administered migraine screener in patients with headache complaints in the primary care setting. METHODS: A total of 563 patients presenting for routine primary care appointments and reporting headaches in the past 3 months completed a self-administered migraine screener. All patients were then referred for an independent diagnostic evaluation by a headache expert, of whom 451 (80%) completed a full evaluation. Migraine diagnosis was assigned based on International Headache Society criteria after completing a semi-structured diagnostic interview. RESULTS: Of nine diagnostic screening questions, a three-item subset of disability, nausea, and sensitivity to light provided optimum performance, with a sensitivity of 0.81 (95% CI, 0.77 to 0.85), a specificity of 0.75 (95% CI, 0.64 to 0.84), and positive predictive value of 0.93 (95% CI, 89.9 to 95.8). Test-retest reliability was good, with a kappa of 0.68 (95% CI, 0.54 to 0.82). The sensitivity and specificity of the three-item migraine screener was similar regardless of sex, age, presence of other comorbid headaches, or previous diagnostic status. CONCLUSIONS: The three-item ID Migraine migraine screener was found to be a valid and reliable screening instrument for migraine headaches. Its ease of use and operating characteristics suggest that it could significantly improve migraine recognition in primary care. |
文献 PubMed−ID |
PMID: 12913201 |
エビデンスレベル |
N/A |
研究施設 |
Department of Neurology, Albert Einstein College of Medicine, Bronx , NY 10461 , USA . |
研究期間 |
不明 |
介入 |
563人の頭痛患者． |
主要評価項目とそれに用いた統計学的手法 |
9つの質問事項と日常生活の障害，嘔気，光への感受性に関しスクリーナを作成．頭痛専門医と診断と比較． |
結果 |
片頭痛の診断に感受性 0.81 (95% CI, 0.77 to 0.85), 特異性が 0.75 (95% CI, 0.64 to 0.84) であった． The three-item ID Migraine migraine screener は有効で片頭痛の診断に有用なものである |
作成者 |
濱田潤一， 清水利彦 |
論文抄録 |
Despite repeated initiatives over the past decade, migraine remains under-recognised, under-diagnosed and under-treated in everyday clinical practice. The Migraine in Primary Care Advisors (MIPCA) group has produced new guidelines for migraine management to attempt to rectify this situation. MIPCA is a group of physicians, nurses, pharmacists and other healthcare professionals dedicated to the improvement of headache management in primary care, who have also worked closely with the Migraine Action Association (the UK patients' group) in the development of these guidelines. The principles of the new MIPCA guidelines are: To arrange specific consultations for headache. To institute a system of detailed history taking, patient education and buy-in at the outset of the consultation. To utilise a new screening algorithm for the differential diagnosis of headache, which can be confirmed by further questioning, if necessary. To institute a process of management that is individualised for each patient, using a new algorithm. Assessing the impact on the patient's daily life is a key aspect of diagnosis and management. To prescribe only treatments that have objective evidence of favourable efficacy and tolerability. To utilise prospective follow-up procedures to monitor the success of treatment. To organise a team approach to headache management in primary care. |
文献 PubMed−ID |
PMID: 12487508 |
エビデンスレベル |
N/A |
文献タイトル (日本語) |
プライマリーケアーにおける片頭痛のマネージメントの新しいガイドライン |
目的 |
プライマリーケアー医に片頭痛を認識させ正しい診断，治療をさせる． |
研究施設 |
King's Headache Service, King's College Hospital , London , UK . |
研究期間 |
不明 |
介入 |
The Migraine in Primary Care Advisors (MIPCA) グループが新しいガイドラインを作成． MIPCA は内科医，看護士，薬剤師，その他頭痛マネージメントを改善させる医療関係者からなる． |
結果 |
新しい MIPCA ガイドラインの基本は以下の通り． 頭痛に対し専門的依頼をアレンジする． 問診の詳細なとり方 , 患者教育，依頼のシステムの設定を行う． 頭痛の鑑別に必要なさまざまな質問で診断が進められる新しいアルゴリズムを利用する．各患者に対し，新しいアルゴリズムを用いそれぞれのマネージメントの過程を設定する．患者ごとの日常生活の影響の評価は診断と管理の一部分の鍵である． 良好な効果と認容性が他覚的に得られているエビデンスのある治療のみを行う． 治療効果を観察するのに prospective な方法による経過観察を行う． プライマリーケアで頭痛治療をおこなうチームを作成する． |
備考 |
Publication Types: ・Guideline ・ Practice Guideline MeSH Terms: ・ Algorithms |
作成者 |
濱田潤一， 清水利彦 |