Diagnoses and Symptom Patterns in Children Presenting to a Pediatric Headache Clinic

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.

Childhood headaches: discrete entities or continuum?

“…The majority of children in the study had bilateral headaches which would be in keeping with many of the previous studies of children (Congdon and Forsythe 1979, Barlow 1984, Gladstein et al 1993, Seshia et al 1994. Rossi et al (1992) reported that 50% of the study population complained of the throbbing quafity of their headaches.…”

Enxaqueca na infância: dificuldades diagnósticas

“…Esta variabilidade tem sido encontrada em outras avaliações de pacientes pediátricos 4,5,12,13 , determinando propostas que alteram os critérios conhecidos -principalmente o da enxaqueca sem aura da IHS, visando torná-lo mais específico a esta faixa etária.…”

“…Tanto isto é verdade que a IHS acrescentou, em seu critério, um adendo diminuíndo de 4 para 2 horas o tempo mínimo exigido para o diagnóstico da enxaqueca sem aura, na infância. Contudo, alguns estudiosos 2,[4][5][6][7]12 afirmam que as crianças, na sua maioria, ainda têm crises menos prolongadas e que o período de uma hora ou menos seria suficiente para a determinação diagnóstica. Considerando, no grupo estudado por nós, os 36 casos classificados como enxaqueca sem aura pelo critério da IHS -associados ou não aos demais critérios -verificamos que 15 pacientes tinham crises que duravam menos do que 2 horas, 5 sofriam de crises que variavam de 2 a 4 horas, e 16 apresentavam crises de mais de 4 horas.…”

“…A análise dos questionários pretendia avaliar quantos casos de enxaqueca sem auraoutrora denominada de enxaqueca comumpoderiam ser diagnósticados utilizando-se os critérios de Valhquist (Quadro 1), de Prensky (Quadro 2) e o da IHS (Quadro 3). É importante ressaltar que na aplicação do critério da IHS não foi respeitada a exigência de que a crise de dor de cabeça tivesse, pelo menos, 2 horas de duração, uma vez que se reconhece que as enxaquecas infantis são menos prolongadas do que as dos adultos [4][5][6][7][8] .…”

Decreasing the minimal duration of the attack to 1 hour: is this sufficient to increase the sensitivity of the ICHD-II diagnostic criteria for migraine in childhood?

“…Since 1992, many papers have shown the high specificity but low sensitivity of ICHD-I diagnostic criteria for migraine without aura in childhood [3][4][5][6][7][8][9][10][11][12][13][14][15]. Several published series have shown that the percentage of children in which the attack duration is less than 2 hours ranged from 11% to 32% [3,5,7,8,11].…”