E-diary use in clinical headache practice: A prospective observational study

Cephalalgia. 2021 Oct;41(11-12):1161-1171. doi: 10.1177/03331024211010306. Epub 2021 May 2.


Aim: To determine whether our E-diary can be used to diagnose migraine and provide more reliable migraine-related frequency numbers compared to patients' self-reported estimates.

Methods: We introduced a self-developed E-diary including automated algorithms differentiating headache and migraine days, indicating whether a patient has migraine. Reliability of the E-diary diagnosis in combination with two previously validated E-questionnaires was compared to a physician's diagnosis as gold standard in headache patients referred to the Leiden Headache Clinic (n = 596). In a subset of patients with migraine (n = 484), self-estimated migraine-related frequencies were compared to diary-based results.

Results: The first migraine screening approach including an E-headache questionnaire, and the E-diary revealed a sensitivity of 98% and specificity of 17%. In the second approach, an E-migraine questionnaire was added, resulting in a sensitivity of 79% and specificity of 69%. Mean self-estimated monthly migraine days, non-migrainous headache days and days with acute medication use were different from E-diary-based results (absolute mean difference ± standard deviation respectively 4.7 ± 5.0, 6.2 ± 6.6 and 4.3 ± 4.8).

Conclusion: The E-diary including algorithms differentiating headache and migraine days showed usefulness in diagnosing migraine. The use emphasised the need for E-diaries to obtain reliable information, as patients do not reliably recall numbers of migraine days and acute medication intake. Adding E-diaries will be helpful in future headache telemedicine.

Keywords: Telemedicine; data reliability; electronic diary; migraine.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Headache* / diagnosis
  • Headache* / epidemiology
  • Humans
  • Migraine Disorders* / diagnosis
  • Migraine Disorders* / epidemiology
  • Prospective Studies
  • Reproducibility of Results
  • Surveys and Questionnaires