Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

Ph.D. in Psychology



First Advisor

Todd A. Smitherman

Second Advisor

Marc Showalter

Third Advisor

John N. Young

Relational Format



Migraine is a commonly-occurring primary headache disorder that can be extremely disabling. Despite its prevalence and impact, migraine remains under-recognized and under-treated. The US Headache Consortium recommended validated screening measures as one way to improve headache diagnosis. Previous studies have sought to determine optimal symptom algorithms for differentiating migraine from other types of headache or to validate migraine screening measures, but few studies have attempted to do both. The current study attempted to statistically determine the most sensitive and specific symptoms for differentiating between migraine and other headache and validate the resulting symptom algorithm as a screening measure. Young adults who suffered from migraine (Group 1) and other headache (Group 2), based on their responses on a computerized diagnostic interview, served as participants. The total sample consisted of 1,829 participants (71.5% female; 74.4% white; mean age = 19.09 years [SD = 2.05]) who suffered from some type of headache, which was split randomly into experimental and validation samples. One hundred fifty-eight (8.6%) individuals met diagnostic criteria for migraine and 1,104 (60.3%) met for another type of headache. Headache duration of 4-72 hours (100%), severity ≥ 5 (91%), photophobia (90%), and phonophobia (90%) shothe highest sensitivity, while vomiting (98%), duration of 4-72 hours (92%), nausea (89%), and headache-related disability (88%) shothe highest specificity. Symptoms that did not show either a positive likelihood ratio > 4.5 or negative likelihood ratio < 0.25 were eliminated. A backward stepwise logistic regression analysis was performed on the remaining symptoms and resulted in an optimal model of duration of 4-72 hours, nausea, photophobia, and phonophobia. ROC curve analyses shothat these items had an optimal operating point (OOP) of 3 out of 4 symptom endorsements, showing a sensitivity of 94%, a specificity of 92%, and an AUC of 93% (+LR = 12.37, -LR = 0.06, PPV = 67%, NPV = 99%). The current migraine screener performed much better than previous screening measures and has utility in identifying migraine among non-clinical and young adult samples. Potential uses of this screening measure are discussed, as are limitations of the current study and possible future directions.


Emphasis: Clinical Psychology

Included in

Psychology Commons



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