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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

The Journal of Headache and Pain 1/2014

Validation of a guideline-based decision support system for the diagnosis of primary headache disorders based on ICHD-3 beta

The Journal of Headache and Pain > Ausgabe 1/2014
Zhao Dong, Ziming Yin, Mianwang He, Xiaoyan Chen, Xudong Lv, Shengyuan Yu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1129-2377-15-40) contains supplementary material, which is available to authorized users.
Zhao Dong, Ziming Yin contributed equally to this work.

Competing interests

All authors declare there are no financial competing interests (political, personal, religious, ideological, academic, intellectual, commercial or any other) in relation to this manuscript.

Authors’ contributions

ZD, ZY, MH, XC and XL carried out the studies. ZD and ZY participated in the design of the study and drafted the manuscript. ZD and MH performed the statistical analysis. Professor SY, the PI of this study, conceived of the study and participated in its design and helped to draft the manuscript. All authors read and approved the final manuscript.



China may have the largest population of headache sufferers and therefore the most serious burden of disease worldwide. However, the rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. The use of computerized clinical decision support systems (CDSS) seems to be a better choice to solve this problem.


We developed a headache CDSS based on ICHD-3 beta and validated it in a prospective study that included 543 headache patients from the International Headache Center at the Chinese PLA General hospital, Beijing, China.


We found that the CDSS correctly recognized 159/160 (99.4%) of migraine without aura, 36/36 (100%) of migraine with aura, 20/21 (95.2%) of chronic migraine, and 37/59 (62.7%) of probable migraine. This system also correctly identified 157/180 (87.2%) of patients with tension-type headache (TTH), of which infrequent episodic TTH was diagnosed in 12/13 (92.3%), frequent episodic TTH was diagnosed in 99/101 (98.0%), chronic TTH in 18/20 (90.0%), and probable TTH in 28/46 (60.9%). The correct diagnostic rates of cluster headache and new daily persistent headache (NDPH) were 90.0% and 100%, respectively. In addition, the system recognized 32/32 (100%) of patients with medication overuse headache.


With high diagnostic accuracy for most of the primary and some types of secondary headaches, this system can be expected to help general practitioners at primary hospitals improve diagnostic accuracy and thereby reduce the burden of headache in China.
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