Comparison of continuous headache features in youth with migraine, new daily persistent headache, and persistent post-traumatic headache

Abstract

Objective To compare clinical features in youth with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache to determine if they are similar, contrary to their distinction in the International Classification of Headache Disorders. Methods We pursued a single center age- and sex-matched observational study comparing the clinical characteristics of 150 youth (11 – 17 years old) with continuous headache from migraine, persistent post-traumatic headache, and new daily persistent headache. A diagnostic algorithm based on international classification of headache disorders criteria was used to identify those with migraine (headache features of migraine with gradual onset), and persistent post-traumatic headache and new daily persistent headache (based on the circumstances of headache onset regardless of headache features). Fifty participants each with migraine, persistent post-traumatic headache, and new daily persistent headache were matched by age and sex. Participant survey responses on headache characteristics were compared. Results Median usual headache severity was 6.0 [95%CI 6.0, 6.0] and was not different across diagnostic groups (H statistic = 1.2, p = 0.55). Headache exacerbation frequency, disability, associated symptoms, and most triggers were not significantly different across groups. The majority of persistent post-traumatic headache and new daily persistent headache had headache features consistent with a diagnose of migraine (72% and 62%, respectively). Conclusion Our findings suggest that most persistent post-traumatic headache and new daily persistent headache may represent abrupt onset of migraine.

Symptoms associated with headache in youth

“…Our measures were based on patient response, which is subject to misinterpretation and recall bias. In our prior work with this dataset, we found some discrepancy between patient responses and provider documentation that could impact ICHD-3 diagnosis in one third of entries (8). Selection bias also could have impacted our results as there were demographic differences between those excluded.…”

“…All analyses were performed using custom written code in Matlab (Mathworks, Natick, MA), which is publicly available (9).…”

“…PedMIDAS grade (no, mild, moderate, or severe disability) was used because there was a large skew in the distribution of the raw scores. ICHD-3 diagnosis was made based on a diagnostic algorithm applied to the patient survey data, which we have described in our prior work from this database (8).…”

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies

“…Although the most predictive characteristics of the diagnosis of migraine include nausea, vomiting, photo, and phonophobia, it has been indicated that these symptoms together in addition to the intensity of the pain are not useful in the emergency departments to establish a difference. This is due to the high probability of finding these same symptoms in headache syndromes, regardless of their etiology [ 26 ]. Moreover, it is important to highlight that there is no classification to score nausea or vomiting associated with the headache, but they are part of the clinical manifestations of some primary headaches.…”

“…It has been described that tension-type headache is the most common type of primary headache [ 26 ], while others have indicated that it is a migraine followed by unspecified headache [ 27 ]. These diagnostic differences may be due to overcrowding in emergency services, the short time to obtain a detailed clinical history of the headache, and the difficulty in obtaining an accurate history of the patient's headache during the painful phase.…”