Critical Analysis of the International Classification of Headache Disorders Diagnostic Criteria (ICHD I-1988) and (ICHD II-2004), for Migraine in Children and Adolescents

Abstract

The present study analyzed the (ICHD I-1988) and (ICHD II-2004) diagnostic criteria in children and adolescents. Our population consisted of 496 patients of the Headache Outpatient Ward for Children and Adolescents retrospectively studied from 1992 to 2002. Individuals were classified according to three diagnostic groups: Intuitive Clinical Diagnosis (Gold Standard), ICHD I-1988 and ICHD II-2004. They were statistically compared using the variables: Sensitivity (S), Specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV). When ICHD I-1988 was used, the sensitivity of migraine without and with aura was 21% and 27%, respectively, whereas in ICHD II-2004 it changed to 53% and 71% without affecting specificity. As a conclusion, the current classification criteria (ICHD II-2004) showed greater sensitivity and high specificity for migraine than ICHD I-1988, although it improved migraine diagnosis in children and adolescents, the sensitivity remains poor.

Analysis of the International Classification of Headache Disorders for diagnosis of migraine and tension‐type headache in children

“…Few studies have analysed the use of the ICHD-II for classification of children with headaches. One of these regards children with the same mean age as those in our study 2 and shows slightly higher percentages of MO and of probable cases of MO. Another study on older children shows similar percentages of MO or probable MO and of TTH or probable TTH.…”

“…This study shows that: (1) the variables used in the ICHD-II describe the two main types of primary headache (MO and TTH) well; however, many children remain unclassifiable; (2) in the classification, behaviour during episodes is an intensity measure that is simple to apply even for the youngest children, the more severe types of behaviour being associated with MO; and (3) acceptance of 1-hour duration for MO does not seem to significantly change the number of children classified as MO. Other changes in the classification criteria suggested by other authors should not be introduced.…”

“…Recently, some authors reported that the ICHD-II, in the diagnosis of migraine, 'has a poor sensitivity when compared with an intuitive diagnosis'. 2 Several authors have proposed modifications to the classification criteria specifically for MO in children. The most important modifications are: reduction of attack duration to 1 hour independently of corroboration by diary; [3][4][5][6][7][8][9][10][11] acceptance of bi-frontal localization of pain; 3,9 and acceptance of only either phonophobia or photophobia.…”

Diagnosing migraine in the pediatric population

“…A series of studies on the diagnosis of headache in children and adolescents provides an empiric basis for recommending revisions to the ICHD-II criteria for migraine in the pediatric population [1,2••, [3][4][5][6][7][8][9][10][11]. Continued revisions and emerging new criteria should provide important tools for clinical practice, clinical trials, and epidemiologic research.…”

“…In the ICHD-II system, the primary headache disorders (migraine, tension-type headache, and cluster headache) are defined based on the symptom profiles and on the pattern of headache attacks [3,4]. The general medical and neurologic examinations, as well as diagnostic tests, serve primarily to exclude secondary headaches.…”