Optimizing the diagnosis and treatment of migraine.

PURPOSE: To describe and discuss short headache questionnaires, which can simplify and improve the diagnosis of migraine. DATA SOURCES: Review of the worldwide scientific literature on short diagnostic questionnaires for migraine. CONCLUSIONS: A new three-question Headache Screen addressing disability due to recurring headaches, headache duration, and changes in headache characteristics and/or pattern over the previous 6 months displayed high sensitivity when used to survey >3000 migraineurs, correctly identifying 77% of migraineurs diagnosed by International Headache Society (IHS) criteria, clinical impression, or the presence of recurring, disabling headaches. IMPLICATIONS FOR PRACTICE: The underdiagnosis and undertreatment of migraine are problems that may be attributed to many causes involving both patients and medical providers. These include stringent diagnostic criteria established by the IHS, which fail to easily classify many common migraine presentations, the lack of clear outcome measures of successful management of migraine, and failure to recognize the iatrogenic role of prescription and nonprescription medications as an etiologic factor in chronic daily headache. The recent development of reliable, clinically useful, short headache questionnaires that are focused on headache impact facilitates the understanding and diagnosis of migraine for both patients and healthcare professionals. As a diagnostic tool, the Headache Screen has the potential to expand appropriate medication use, leading to improved functional status and quality of life for migraineurs.