The value of nonfactual information in distinguishing primary from secondary headache disorders results of a Delphi study

Objective
To collect pairs of nonfactual information and their interpretations and rate their usefulness in distinguishing between primary and secondary headache disorders.

Background
Physicians use clinical indicators such as Red Flags and ask about exposure to potential causes to differentiate primary from secondary headaches; however, these approaches have limitations and may result in unnecessary diagnostic procedures.

Methods
Using the Delphi process, the participants proposed information-interpretation pairs in the first round and rated them anonymously in two subsequent rounds. The ratings relied on quality estimators to evaluate the reliability, validity, relevance, and frequency on 5-point Likert scales, ranging from 0 to 5. We considered pairs with an average rating of 4.0 or higher to have reached consensus.

Results
Four proposals reached consensus, of which two referred to nonfactual information: (i) “A headache that feels familiar indicates a primary headache.” (ii) “A headache that feels completely different from any previous headache raises the suspicion of a secondary headache.”

Conclusions
The participants generally found little use for nonfactual information for distinguishing between primary and secondary headache disorders. Solely the presence and absence of patients’ notion of a familiar headache were deemed helpful. While the participants viewed the former as being associated with a primary headache, they felt that the latter pointed towards a secondary headache. Further research is necessary to evaluate their usefulness in clinical practice.