The American Headache Society (AHS) is recommending annual screening for migraine as part of routine preventive care for girls and women — from adolescence through menopause 

Despite its high prevalence — especially among girls and women — and substantial negative impacts, migraine is “under diagnosed and under treated. Diagnostic screening for migraine enables more patients to receive timely, appropriate, and effective management,” said the guideline authors, led by Todd Schwedt, MD, with the Department of Neurology, Mayo Clinic, Phoenix. 

The position statement was published in the February issue of Headache. 

High Prevalence, Significant Burden

The AHS developed the position statement using its established guideline development procedures and a review of relevant published literature. 

Migraine meets established criteria for screening, given its high prevalence, substantial morbidity, and significant economic and societal burden, along with the availability of validated screening tools and effective treatments that reduce disease impact, the guideline authors noted.

The position statement recommends annual screening for migraine in girls and women beginning at puberty and continuing through menopause, the life stage when migraine incidence and prevalence peak.

Screening can be performed using simple, validated questionnaires based on International Classification of Headache Disorders criteria. The recommended tool is the 3-item ID Migraine screener, which asks whether headaches in the past 3 months have limited daily activities, caused nausea, or been associated with light sensitivity.

Affirmative answers to at least two of the three questions indicate a positive screen for migraine. In validation studies, the ID Migraine screener had a sensitivity of 81% and specificity of 75% for migraine, while a meta-analysis of 13 studies reported pooled sensitivity of 84% and specificity of 76%. 

The tool can be completed in less than 2 minutes and could be incorporated into pre-visit intake forms or electronic health record questionnaires, the writing group noted. 

Patients who screen positive should undergo further evaluation to confirm diagnosis and rule out secondary headache disorders, after which clinicians may initiate evidence-based treatment or refer patients to headache specialists when appropriate, the writing group advised.

Summing up, the authors said integrating migraine screening into routine preventive care for girls and women is a practical and evidence-based strategy to address widespread under diagnosis and reduce the burden of disease.

They said there is also “strong justification” to screen for migraine in boys and men, although a broader discussion in this population was beyond the scope of this position statement. 

That said, the AHS “strongly advocates for appropriate screening, diagnosis, and treatment of migraine for everyone,” the authors wrote. 

This work had no commercial funding. Schwedt has received compensation as a consultant for AbbVie, Linpharma, Lundbeck, and Scilex; royalties from UpToDate; and held stock options in Allevalux and Nocira.