Headache classification by history has only limited predictive value for headache episodes treated in controlled trials with OTC analgesics

H. C. Diener, V. Pfaffenrath, L. Pageler, H. Peil, B. Aicher, Richard B. Lipton

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

We investigated the consistency between the headache diagnosis based on medical history and three treated headache episodes diagnosed based on a diary. In a randomized double-blind study including individuals with either migraine or tension-type headache (TTH) we showed significant superiority of the fixed combination of acetylsalicylic acid + paracetamol + caffeine over the combination without caffeine, the single preparations, and placebo in the treatment of headache. A neurologist performed a classification of the usual headache episodes and each of the three treated ones in a blinded fashion based on a structured questionnaire. This was done for the 1734 patients included in the efficacy analysis who usually treated their episodic TTH or migraine attacks with non-prescription analgesics. The overall percentage of patients with migraine and TTH remained relatively stable. The treated headache episodes were between 75 and 77% migraine, 18-20% were TTH and 5-7% could not be classified. We observed some shift in headache type within patients from prior history and in treated attacks. In 60% of patients all three treated episodes were of the type initially diagnosed by the neurologist by history (56% migraine and 4% episodic TTH). Of those with an initial diagnosis of migraine, 24% had at least one attack meeting criteria for TTH. Of patients with an initial diagnosis of TTH, 54% had at least one attack meeting the diagnostic criteria for migraine. Our results demonstrate that an initial headache diagnosis does not accurately predict the headache type treated in a randomized trial. Symptom features of treated headaches should be captured to ensure that the attack is of the type targeted by the clinical trial. The International Headache Society Guidelines for controlled clinical trials should be updated accordingly.

Original languageEnglish (US)
Pages (from-to)188-193
Number of pages6
JournalCephalalgia
Volume29
Issue number2
DOIs
StatePublished - Feb 2009

Fingerprint

Tension-Type Headache
Headache
Analgesics
History
Migraine Disorders
Caffeine
Controlled Clinical Trials
Acetaminophen
Double-Blind Method
Aspirin
Placebos
Clinical Trials
Guidelines

Keywords

  • Combination analgesic
  • Controlled clinical trial
  • Headache classification
  • Headache history
  • Migraine
  • Over-the-counter (OTC) analgesic
  • Tension-type headache

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Headache classification by history has only limited predictive value for headache episodes treated in controlled trials with OTC analgesics. / Diener, H. C.; Pfaffenrath, V.; Pageler, L.; Peil, H.; Aicher, B.; Lipton, Richard B.

In: Cephalalgia, Vol. 29, No. 2, 02.2009, p. 188-193.

Research output: Contribution to journalArticle

Diener, H. C. ; Pfaffenrath, V. ; Pageler, L. ; Peil, H. ; Aicher, B. ; Lipton, Richard B. / Headache classification by history has only limited predictive value for headache episodes treated in controlled trials with OTC analgesics. In: Cephalalgia. 2009 ; Vol. 29, No. 2. pp. 188-193.
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