Modification of ICHD-II criteria to include bilateral headache, headache duration of 1 to 72 hours, and nausea and/or vomiting plus two of five other associated symptoms (photophobia, phonophobia, difficulty thinking, lightheadedness, or fatigue), in addition to the usual description of moderate to severe pain of a throbbing or pulsating nature worsening or limiting physical activity, improved sensitivity of migraine diagnosis to 84.4%.

No abstract

The diagnosis of migraine headache in children and adolescents is complex and not well understood. This study was conducted to compare diagnostic rates, using various criteria for pediatric migraine, and specific symptom characteristics in a sample of children referred for care to a specialized pediatric headache clinic. A structured interview was used at the patient's initial assessment visit to elicit symptom patterns and therapies attempted for headache. Clinical diagnoses were based on consensus agreement reached by a multidisciplinary team. Statistically derived diagnostic rates based on International Headache Society (IHS), Prensky, Vahlquist and our own criteria were significantly lower than clinical diagnostic rates. IHS diagnostic rates were differentially distributed as a function of race, but no other effects were found for demographic variables on diagnostic rates. Specific symptom patterns, however, varied as a function of race, gender and age of the child. The results underscore the need for comprehensive, developmentally based models of the evolution of migraine headache as a foundation for future research and the further development of clinically sensitive diagnostic criteria for pediatric migraine.

Our data suggest that rather than having two coexistent headache types, children and adolescents with chronic daily headache have a single syndrome that, in many cases, will paroxysmally worsen and gather migrainous features.

Chronic daily headache in children and adolescents has not been well described. We analyzed data for 37 children and adolescents who presented with chronic daily headache to our Pediatric Headache Clinic over a 2-year period. These youngsters had five distinct headache patterns; 40% of them had the "comorbid" pattern, 35% were classified with new daily persistent headache, 15% with transformed migraine, 5% with chronic tension-type headache, and 5% could not be classified. There were no significant differences by diagnosis in externalizing and internalizing behaviors, type A behaviors, disability, pain severity, days missed from school, and number of coping skills employed. Children and adolescents with chronic daily headache have distinct clinical patterns, but for the most part, have similar disability. Differences between adult and childhood chronic daily headache are emphasized.