Evaluation of diagnostic and prognostic value of clinical characteristics of Migraine and Tension type headache included in the diagnostic criteria for children and adolescents in International Classification of Headache Disorders - second edition

Abstract

Summary Data about the sensitivity and the specificity of the items included in the diagnostic criteria for migraine and tension type headache (TTH) in children is limited and sometimes controversial. Aim: To evaluate the diagnostic value of characteristics of migraine and TTH included in the diagnostic criteria of ICHD–II and according to results to suggest additional criteria for diagnostic differentiation of primary paediatric headache. Patients and methods: The investigation consisted of an epidemiological school‐based study (1029 pupils completed the study and 412 had chronic or recurrent headache) and a clinical study conducted in Paediatric Neurology Ward and outpatient clinic (203 patients with chronic or recurrent headache). Inclusion criterion was at least two episodes of headache during the last year. Exclusion criteria were: headache occurring only during acute infections; withdrawal of informed consent. ICHD – II was used to classify headache. The diagnostic value of characteristics of migraine and TTH was measured using sensitivity, specificity, odds ratio and area under receiver operating characteristic curve (AUC). Results: Regarding the AUC, the best diagnostic items for migraine are: moderate or severe intensity or only severe intensity, pain aggravation by physical activity, pulsating quality, respectively, for TTH – no photophobia, no nausea, no aggravation by physical activity, mild or moderate intensity and non‐pulsating quality. The most significant symptom for increasing the migraine risk was pulsating pain and the most significant items for TTH risk were no photophobia, bilateral location and no nausea. Family history of migraine also increased migraine risk and could be either included in the diagnostic criteria for migraine or recommended as additional item in differentiating migraine and TTH with overlapping diagnostic criteria. According to AUC, we could recommend changing the content of the item of intensity for migraine as only severe intensity.

Diagnostic value of combinations of symptoms of migraine and tension-type headache included in the diagnostic criteria for children and adolescents in the international classification of headache disorders 2nd edition

“…Nausea was reported to be a symptom with good sensitivity and specifi city by other authors and they considered it as an important differential diagnostic feature between migraine and TTH. 11,12 "Photophobia and phonophobia" increased the risk only 5 1/2-fold. Therefore the new content of this item in ICHD -II -photophobia and/or phonophobia is more reliable.…”

“…Mild intensity and pressing-tightening quality are symptoms with high specifi city for TTH. 12,15,18,19 Gallai et al considered that the symptom mild to moderate intensity should be an obligatory criterion for TTH, while moderate to severe intensity -obligatory for migraine. 19 The item no pain aggravation by routine physical activity had high sensitivity and high specifi city for TTH according to most of the existing data in the literature.…”

“…According to the literature unilateral location and severe intensity are the symptoms with high specifi city for migraine. [11][12][13] This fact could explain their existence in the combination, which made the diagnosis of migraine certain. The diagnostic role of the other symptom in this combination -pain aggravation by physical activity is controversial.…”

“…6,[14][15][16] However, there are authors who consider it as an important differential factor between migraine and TTH in children. 12,15,16 The combinations: "migrainous location, severe intensity, pain aggravation by physical activity", "severe intensity, nausea", "pulsating quality, nausea" and "migrainous location, pulsating quality, pain aggravation by physical activity" increased the most the migraine risk and could be recommended ate the group of overlapping headache. Thus 50% of these children were classifi ed as TTH and 8.3% as MWA (Fig.…”

Spectral Analyses of Heart Rate Variability by Acceleration Plethysmography for Diagnostic Support of Migraine: Clinical Research

“…We collected the data of LF, HF and LF/HF, and found HF ratio by orthostatic load as a supportive diagnostic measure for migraine. Because diagnoses of headache according to ICHD-II alone might have some difficulties in daily clinical settings [22], our method will be a helpful tool for differential diagnoses. According to Task Force of the European Society of Cardiology and the North American Society of Pacing and Eliectophysiology, the data collection required at least two minutes to obtain reliable results [23].…”