An Examination of the Validity of the IHS Classification System for Migraine and Tension‐Type Headache in the College Student Population

Abstract

The validity of the International Headache Society (IHS) classification system for college-aged students with headache was examined using cluster analysis. Undergraduate college student volunteers (N = 369) underwent a structured diagnostic interview for headaches, and the sample was divided into two subsamples for purposes of replication. A hierarchical cluster analysis (Ward's method) of the headache characteristics reported by the first subsample suggested a statistically distinct three-cluster solution, and the solution was replicated using the second subsample. It appeared that one cluster was tensionlike, while the other two were migrainelike. Nonhierarchical cluster analyses (K-means) of the cases from each subsample revealed a similar pattern of a tensionlike and two migrainelike clusters. Identical three-cluster solutions were found for the second subsample both by using cluster centers from the first subsample and by clustering the cases independently, suggesting that the cluster solution was not a random finding. The IHS classification system appears to lack adequate specificity and sensitivity for college-aged students with headache who report migrainelike symptoms. Thus, the generalizability of research results using college-aged students with headache to the adult population may be questionable.

Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache

“…Given the well-established relation between headache frequency and medication overuse, migraineurs who overuse medications also commonly experience a progressive reduction in migraine-associated features and develop headaches that more closely resemble TTH [5,29]. Rokicki and colleagues [43] found a mixed presentation of TTH and migraine symptoms among a college-aged sample, and others have shown a similar mixed pattern of headache symptoms in children and adolescents, with unilateral distribution becoming more prominent with age [22,53]. …”

“…We hypothesized that historical clinical perceptions would be supported in that there would be evidence of taxometrically different ‘types’ of headaches. However, in light of data indicating less distinct phenotypes among individuals with frequent headaches [5] and those of younger age [43,53], we posited that diagnostic/symptomatic distinctions between headache types would be less prominent among the latter subgroups.…”

“…The conceptualization of migraine and TTH as distinct phenomena has not gone unchallenged [6,20,40,43]. An alternative perspective— the continuum severity model—holds that these headache ‘types’ instead represent points on a single continuum of severity, with migraine falling at the more severe end of the symptom spectrum [4,10,27,30,48,56] Findings from a latent class analysis of migraine have indicated a severity continuum among patients with and without aura [34].…”

Chronic daily headache: When to suspect sinus disease

“…The IHS does not consider CRS a valid cause of facial pain or headache, yet many cases of "sinus headache" are thought to represent undiagnosed migraine because they satisfy IHS criteria [12•]. Multiple studies have cast doubt as to the validity of using IHS criteria as a gold standard to diagnose migraine, rather than physician evaluation [13][14][15]. In fact, many nonmigraine episodes (eg, head trauma) can qualify for at least a migrainous episode per IHS criteria until actual physician assessment is made [16•].…”

Promote Biomarker Discovery by Identifying Homogenous Primary Headache Subgroups

“…Subgroup identification (eg, based on genetic, clinical feature, comorbidity, and trigger profiles across headache categories) would capture if patients diagnosed with different disorders have overlapping profiles (eg, in regards to clinical features) . Construction of subgroups based on these data levels across headache categories would also be useful to account for the following: Clustering of headache patients based on clinical features supported the diagnostic criteria in adults, in contrast to findings in young adults and children . Subsequently, biochemical profiles can be investigated across clusters.…”