Reliability of headache diagnosis

The literature on diagnosis of head pain associated with psychological factors indicates that these diagnoses rely almost exclusively on self-report criteria. The reliability of self-report criteria for diagnosis of headache has not been previously reported. The present study investigated the reliability of headache diagnosis based on the criteria suggested by the Ad Hoc Committee on Classification of Headache. The results indicated modest rater agreement. It was concluded that the headache literature may be confounded by unreliable diagnostic procedures. Improved methods of classifying headache types using self-report, behavioral, and physiological measures during pain-free and headache states are required before adequate reliability of headache classification can be achieved. It is suggested that reliable and valid measurement and classification would eliminate much of the confusion currently existing in the headache literature.