Screening for Cluster Headache—Introduction of the SMARTED Scale

Round 1

Reviewer 1 Report

An easy-to-use questionnaire for the diagnosis of cluster headache would be very useful. In the introduction it would have been useful for the authors to provide a summary of the previous studies which have looked at screening questionnaires for cluster headache. It would be good to know what purpose the prior publications addressed; for example, for population-based studies, diagnosis in primary or secondary care? How large were the populations screened, what was their composition, and what where the results of the screening tools. From this should evolve the purpose of developing another screening questionnaire. Otherwise, publications addressing the same issue increases, each purporting novelty but none which are unifying enough to put into practice clinically. The authors do comment that most of the others were to primarily distinguish between cluster headache and migraine or tension type headaches whilst the current screener was also to differentiate from other types of primary headache including the other TACs.

Whether one would need this to differentiate from other trigeminal autonomic cephalalgias, is questionable. The latter is on the basis that all patients with any type of TAC should ultimately be seen by a neurologist. Therefore, the main issue here is a diagnostic delay in cluster headache at primary care level. This will largely be because of the rarity of the disorder which is still far more common than the rest of the TACs. Moreover, there does not seem to be a huge issue in the differentiation of cluster headache from other types of primary headache which populate chapter 4 in part one of the Primary headaches of the International Classification for Headache Disorders.

 

Therefore, in summary it would be useful for the authors provide a basis for developing a new questionnaire, summarising what has been published beforehand and making the case for the need for another questionnaire and the unmet need which drives such a development.

It is best published as a pilot study which could be taken forward in multiple centres to obtain a sizeable patient cohort. 

 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear Authors; I found this paper topic very very interesting on the screening for cluster headache. However, before further processing it further it needs some extra work. Regards. P.S.

[1] Writing:

1-1 References: Make them in MDPI format. For example, years are in bold font.

1-2 Abbreviations: Add list of used abbreviation in the work and their expansions at the end right before reference section.

1-3 Section"2.Materials& Methods":  Numerize its subsections.

1-4 Section "3.Results":  Add subsections titles: "3.1. Descriptive Results";  "3.2. Logistic Regression Results"

1-5 Section "4.discussion": Add subsection titles: "4.1. Summary & Contributions", "4.2. Strengths & Limitations" and "4.3. Future Work".

1-6 Add subsection "4.3. Future Work" and present a paragraph with several potential directions.

[2] Statistical:

Very high AUC of 0.938 is very promising sign of the new proposed SMARTED diagnostic tool.

2-1 How did you match cases and controls prior to analysis?  Propensity score, stratification? what? explain it in the manuscript.

2-2 Did your logistic models include "age" and "gender" as controlling variables ? If yes, mention it in the work. Report their model outputs in the Table.1 and Table.2. If no, rerun all models from the start with these two variables included as covariates in the model. Update the results then. Note that with this inclusion the logistic model is flawed and the entire  results are under question.

2-3 Explains very wide 95%CI in the Table.3. It appears a bit unusual. Add it in the discussion section.

2-4 Add a figure on the trajectory of the model in terms of age with the 95%CI predicted values

from the logistic model(age range: 30, 35,40, 45, 50, 55, 60). Comment on it in the section "3.2. Logistic Regression Results". See this paper to get the ideas: Last Figure.5.

Link:  https://www.mdpi.com/1660-4601/16/8/1347

2-5: Cite SPSS in the reference section:

*IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Dear Authors; my main concerns were addressed satisfactorily. Regards.