Objective: Correctly diagnosing headache disorders presents significant challenges, especially at the primary and secondary levels of care (PSLC), often leading to misdiagnoses and underdiagnoses. This study aims to assess the diagnostic agreement for migraine, tension-type headache (TTH), and cluster headache (CH) between PSLC and the tertiary level of care (TLC), as well as to evaluate adherence to the International Classification of Headache Disorders, 3rd edition (ICHD-3) guidelines.
Methods: This cross-sectional study involved patients visiting the tertiary headache center of Charité - Universitätsmedizin Berlin for the first time. Data on headache characteristics and diagnoses were collected from standardized anamnesis questionnaires and doctors' letters. Diagnostic agreement was assessed using Cohen's Kappa (κ) statistics.
Results: The study cohort consisted of 1,468 patients (43.4 ± 14.4 years; 74.5% women). A total of 69.5% received a headache diagnosis at PSLC, whereas 99.5% were diagnosed during their first visit at TLC. Of the 1,457 migraine, TTH, and CH diagnoses given in PSLC, 948 (65.1%) were confirmed in TLC, κ=0.546 (95%CI 0.519 - 0.573), p<0.001 (Figure 1). From the 1,112 diagnoses meeting all ICHD-3 criteria for migraine, TTH, and CH, 749 (67.4%) received the respective diagnosis in PSLC (κ=0.596, 95% CI 0.568-0.623, p<0.001), and 1,104 (99.3%) in TLC (κ=0.984, 95% CI 0.978-0.990, p<0.001). TTH was the least correctly diagnosed, with only 32% of patients fulfilling all ICHD-3 criteria for TTH in PSLC.
Conclusion: Our findings indicate substantial diagnostic agreement across different levels of care according to the ICHD-3 guidelines. However, since diagnostic accuracy is essential for optimizing patient care and treatment outcomes, efforts should focus on improving early recognition and diagnostic accuracy of primary headaches.