The diagnostic accuracy of headache measurement instruments: A systematic review and meta-analysis focusing on headaches associated with musculoskeletal symptoms

Contains fulltext : 208202.pdf (publisher's version ) (Open Access)AIM: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms. DESIGN: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966-2018), Cochrane (1898-2018) and Cinahl (1988-2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible, a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument. RESULTS: From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85-0.89) and specificity of 0.75 (95% CI: 0.72-0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire - Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55-0.80) and specificity of 0.90 (95% CI 0.77-0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21-0.54) and specificity of 0.86 (95% CI 0.74-0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72-0.94) and specificity of 0.82 (95% CI 0.73-0.91). DISCUSSION: The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple headaches

Associations of pain intensity and pain-related disability with psychological and socio-demographic factors in patients with temporomandibular disorders:A cross-sectional study at a specialised dental clinic

The study assessed whether psychological and socio-demographic factors, including somatisation, depression, stress, anxiety, daytime sleepiness, optimism, gender and age, are associated with pain intensity and pain-related disability in patients with temporomandibular disorders (TMDs). In total, 320 TMD patients were involved in the study. The psychological status of each patient was assessed with questionnaires, including the Symptom Checklist-90 (SCL-90), Epworth Sleeping Scale (ESS), stress questionnaire and Life Orientation Test-Revised (LOT-R). TMD pain, including pain intensity and pain-related disability, was assessed with characteristic pain intensity (CPI) and disability points scales. The associations of psychological and socio-demographic factors with pain intensity and pain-related disability were assessed through logistic regression analyses. Higher pain intensity was significantly associated with more severe anxiety (P = 0·004), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P = 0·001) and lower optimism (P = 0·025) in univariate regression analyses. However, multiple regression analysis showed that only somatisation was significantly associated with pain intensity (P < 0·001). Higher pain-related disability was significantly associated with more severe anxiety (P < 0·001), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P < 0·001) and lower optimism (P = 0·003) in univariate regression analyses. However, multiple regression analysis showed that only depression was significantly associated with pain-related disability (P = 0·003). Among the psychological and socio-demographic factors in this study, somatisation was the best predictor of pain intensity, while depression was the best predictor of pain-related disability