Construction of a decision-making model for primary headache based on Nomogram

doi:10.3969/j.issn.1674-8115.2021.10.009

Abstract

Abstract: Objective

·To establish a decision-making model for primary headache based on Nomogram.

Methods

·Two hundred and ten patients with migraine or tension-type headache who visited the Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine between October 2019 to December 2020 were studied retrospectively. Among them, 152 patients who visited the hospital from October 2019 to August 2020 were served as the modeling group. Fifty eight patients who visited the hospital from September 2020 to December 2020 were served as the validation group. Univariate and multivariate Logistic regression were used to analyze the independent predictive factors to distinguish migraine and tension-type headache. According to the regression coefficient of independent variables, R software was used to construct a nomogram model of migraine or tension-type headache. The internal verification of the model was carried out through Bootstrap, and the external verification was carried out according to the data of the validation group. Receiver operator characteristic curve (ROC curve), area under the curve (AUC) and calibration curve were used respectively to estimate the discrimination and calibration of the prediction model.

Results

·There were 80 patients with migraines and 72 patients with tension-type headaches in the modeling group. There were 35 patients with migraines and 23 patients with tension-type headaches in the validation group. There was no statistical difference in characteristics between the modeling group and the validation group. According to the results of univariate Logistic analysis, 9 characteristic variables were extracted and included in the multivariate analysis. Multivariate Logistic regression analysis showed the independent predictive factors that were used to distinguish migraine and tension-type headache, including course, whether the headache was located in the occipital, severity intensity of the headache, whether the headache was accompanied by nausea/vomiting, whether the headache was accompanied by photophobia/phonophobia and the change of headache after activities. The decision Nomogram model was constructed based on this result. The internal and external verification of the model found that AUC of the modeling group and the validation group were 0.896 [95% confidence interval (CI) 0.842?0.950] and 0.884 (95%CI 0.793?0.976) respectively, suggesting that the prediction model has a good discrimination capacity.The calibration curve of the modeling group and the validation group was very close to the standard curve, and had a good calibration degree, which showed that the model was consistent in the two groups.

Conclusion

·This study has constructed a decision-making model for distinguishing migraine and tension-type headache based on Nomogram. The model has a good discrimination and calibration in the modeling group and the validation group, which is beneficial to improve clinicians' early identification and diagnosis capabilities for migraine and tension-type headache.

Key words: primary headache, migraine, tension-type headache, decision-making model, model validation, Nomogram

CLC Number:

R741.041

Fang-fang LIU, Guan-shui BAO, Meng-xia YAN. Construction of a decision-making model for primary headache based on Nomogram[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(10): 1323-1329.

Figures/Tables 6

TrendMD

References 16

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Variable	Modeling group （n=152）	Validation group （n=58）	χ² value	P value
Gender / n（%）			0.006	0.939
Male	48 （31.6）	18 （31.0）
Female	104 （68.4）	40 （69.0）
Course / n（%）			0.004	0.947
Within half a year	40 （26.3）	15 （25.9）
More than half a year	112 （73.7）	43 （74.1）
Throbbing / n（%）			3.194	0.074
Yes	19 （12.5）	13 （22.4）
No	133 （87.5）	45 （77.6）
Occipital / n（%）			2.298	0.130
Yes	51 （33.6）	26 （44.8）
No	101 （66.4）	32 （55.2）
Tempus / n（%）			0.900	0.343
Yes	74 （48.7）	24 （41.4）
No	78 （51.3）	34 （58.6）
Severe intensity / n（%）			4.280	0.118
Light	31 （21.7）	17 （29.3）
Medium	85 （55.9）	34 （58.6）
Heavy	36 （22.4）	7 （12.1）
Visual aura symptom / n（%）			0.286	0.593
Yes	13 （8.6）	3 （5.2）
No	139 （91.4）	55 （94.8）
Nausea/vomiting/ n（%）			2.056	0.152
Yes	58 （38.2）	16 （27.6）
No	94 （61.8）	42 （72.4）
Photophobia/phonophobia/ n（%）			2.921	0.087
Yes	31 （20.4）	6 （10.3）
No	121 （79.6）	52 （89.7）
Change of headache after activities/ n（%）			4.553	0.124
Aggravate	55 （36.2）	22 （38.0）
Unchanged	83 （54.6）	35 （60.3）
Relieve	14 （9.2）	1 （1.7）
Related to menstruation/ n（%）			0.111	0.739
Yes	21 （13.8）	7 （12.1）
No	131 （86.2）	51 （87.9）
Alleviative way/ n（%）			6.955	0.064
Persistence	23 （15.1）	4 （6.9）
Rest	53 （34.9）	29 （50.0）
Drug	69 （45.4）	25 （43.1）
Else	7 （4.6）	0
Diagnose / n（%）			1.008	0.315
Migraine	80 （52.6）	35 （61.1）
Tension-type headache	72 （47.4）	23 （39.7）

Variable	Modeling group （n=152）	Validation group （n=58）	χ² value	P value
Gender / n（%）			0.006	0.939
Male	48 （31.6）	18 （31.0）
Female	104 （68.4）	40 （69.0）
Course / n（%）			0.004	0.947
Within half a year	40 （26.3）	15 （25.9）
More than half a year	112 （73.7）	43 （74.1）
Throbbing / n（%）			3.194	0.074
Yes	19 （12.5）	13 （22.4）
No	133 （87.5）	45 （77.6）
Occipital / n（%）			2.298	0.130
Yes	51 （33.6）	26 （44.8）
No	101 （66.4）	32 （55.2）
Tempus / n（%）			0.900	0.343
Yes	74 （48.7）	24 （41.4）
No	78 （51.3）	34 （58.6）
Severe intensity / n（%）			4.280	0.118
Light	31 （21.7）	17 （29.3）
Medium	85 （55.9）	34 （58.6）
Heavy	36 （22.4）	7 （12.1）
Visual aura symptom / n（%）			0.286	0.593
Yes	13 （8.6）	3 （5.2）
No	139 （91.4）	55 （94.8）
Nausea/vomiting/ n（%）			2.056	0.152
Yes	58 （38.2）	16 （27.6）
No	94 （61.8）	42 （72.4）
Photophobia/phonophobia/ n（%）			2.921	0.087
Yes	31 （20.4）	6 （10.3）
No	121 （79.6）	52 （89.7）
Change of headache after activities/ n（%）			4.553	0.124
Aggravate	55 （36.2）	22 （38.0）
Unchanged	83 （54.6）	35 （60.3）
Relieve	14 （9.2）	1 （1.7）
Related to menstruation/ n（%）			0.111	0.739
Yes	21 （13.8）	7 （12.1）
No	131 （86.2）	51 （87.9）
Alleviative way/ n（%）			6.955	0.064
Persistence	23 （15.1）	4 （6.9）
Rest	53 （34.9）	29 （50.0）
Drug	69 （45.4）	25 （43.1）
Else	7 （4.6）	0
Diagnose / n（%）			1.008	0.315
Migraine	80 （52.6）	35 （61.1）
Tension-type headache	72 （47.4）	23 （39.7）

Variable	Univariate Logistic regression			Multivariate Logistic regression
Variable	OR	95%CI	P value	OR	95%CI	P value
Gender	2.047	1.011‒4.146	0.047	NA	NA	NA
Course	3.720	1.660‒8.336	0.001	3.364	1.145‒9.888	0.027
Throbbing	0.616	0.233‒1.629	0.329	‒	‒	‒
Occipital	2.106	1.051‒4.220	0.036	3.271	1.166‒9.181	0.024
Tempus	0.658	0.347‒1.249	0.200	‒	‒	‒
Severe intensity	2.566	1.504‒4.379	0.001	2.036	1.010‒4.104	0.047
Visual Aura symptoms	0.368	0.108‒1.253	0.110	‒	‒	‒
Nausea/vomiting	0.100	0.046‒0.218	0.000	0.094	0.034‒0.260	0.000
Photophobia/phonophobia	0.061	0.018‒0.213	0.000	0.081	0.017‒0.385	0.002
Change of headache after activities	0.396	0.225‒0.696	0.001	0.414	0.199‒0.863	0.019
Related to menstruation	0.233	0.081‒0.675	0.007	NA	NA	NA
Alleviative way	1.504	0.995‒2.274	0.053	NA	NA	NA

Variable	Univariate Logistic regression			Multivariate Logistic regression
Variable	OR	95%CI	P value	OR	95%CI	P value
Gender	2.047	1.011‒4.146	0.047	NA	NA	NA
Course	3.720	1.660‒8.336	0.001	3.364	1.145‒9.888	0.027
Throbbing	0.616	0.233‒1.629	0.329	‒	‒	‒
Occipital	2.106	1.051‒4.220	0.036	3.271	1.166‒9.181	0.024
Tempus	0.658	0.347‒1.249	0.200	‒	‒	‒
Severe intensity	2.566	1.504‒4.379	0.001	2.036	1.010‒4.104	0.047
Visual Aura symptoms	0.368	0.108‒1.253	0.110	‒	‒	‒
Nausea/vomiting	0.100	0.046‒0.218	0.000	0.094	0.034‒0.260	0.000
Photophobia/phonophobia	0.061	0.018‒0.213	0.000	0.081	0.017‒0.385	0.002
Change of headache after activities	0.396	0.225‒0.696	0.001	0.414	0.199‒0.863	0.019
Related to menstruation	0.233	0.081‒0.675	0.007	NA	NA	NA
Alleviative way	1.504	0.995‒2.274	0.053	NA	NA	NA

Variable	Tol	VIF
Gender	0.861	1.162
Course	0.802	1.246
Occipital	0.923	1.083
Severe intensity	0.871	1.148
Nausea/vomiting	0.792	1.263
Photophobia/phonophobia	0.853	1.172
Change of headache after activities	0.903	1.107
Related to menstruation	0.861	1.161
Alleviative way	0.801	1.249