Psychometric validation of E-diary in migraine patients: The association between depression, anxiety and a change in migraine frequency

This quantitative observational study is a sub-project of a larger prospective cohort study conducted at the Headache Center of Leiden University Medical Center about the use of an E-diary in the clinical headache practice for migraine patients. The first objective was to evaluate the psychometric properties of the E-diary to assess migraine characteristics, as the recent development of remote testing makes it fundamental to validate novel E-health instruments. Moreover, migraine has been associated with depression and anxiety. Previous studies found that they predict an increase in migraine frequency years later. The second objective was to examine whether depression and anxiety symptom severity are associated with an increase in migraine frequency three months later. Migraine patients fill in the headache E-diary on a smartphone application, which keeps track of headache attacks daily. It included thirteen items about migraine symptoms, aura characteristics, headache duration and...Show moreThis quantitative observational study is a sub-project of a larger prospective cohort study conducted at the Headache Center of Leiden University Medical Center about the use of an E-diary in the clinical headache practice for migraine patients. The first objective was to evaluate the psychometric properties of the E-diary to assess migraine characteristics, as the recent development of remote testing makes it fundamental to validate novel E-health instruments. Moreover, migraine has been associated with depression and anxiety. Previous studies found that they predict an increase in migraine frequency years later. The second objective was to examine whether depression and anxiety symptom severity are associated with an increase in migraine frequency three months later. Migraine patients fill in the headache E-diary on a smartphone application, which keeps track of headache attacks daily. It included thirteen items about migraine symptoms, aura characteristics, headache duration and triptan use. Psychometric properties were assessed by conducting an item response theory analysis (n = 1417). Depression and anxiety symptom severity were measured with the Hospital Anxiety and Depression Scale. A change in migraine frequency was defined as the difference in migraine days between the first and third month and was measured with the headache E-diary. Linear regressions were performed to test whether the depression and anxiety symptoms were associated with an increase in migraine frequency (n = 725). Twelve items had moderate to very high discrimination values and nine had sequential ordered and positive thresholds. The items properly differentiate migrainous headaches from non-migrainous headaches. The aura, aura duration and unilateral location items were the weakest items. Depression was not associated with a change in migraine frequency (F(1, 723) = 0.32, β = 0.02, p = .573, 95% CI [-0.06, 0.11]), and neither was anxiety (F(1, 723) = 1.07, β = -0.05, p = .301, 95% CI [-0.13, 0.04]). In conclusion, the headache E-diary measures migraine risk accurately and the findings of this study contribute to the validity of the E-diary. It could be that three months is too little time to show the relationship between depression, anxiety, and a change in migraine frequency.Show less

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Psychometric validation of E-diary in migraine patients: The association between depression, anxiety and a change in migraine frequency