IHS Criteria for Migraine and Tension‐Type Headache in Children and Adolescents

Abstract

We investigated the influence of age on the IHS criteria for migraine and tension-type headache in 437 consecutive children and adolescents and found the following age-associated statistically significant differences: migraine duration, occurrence of migraine aura, and bilateral location of tension-type headache were more often fulfilled by adolescents, whereas aggravation of headache by physical activity (in migrainous disorder) and photophobia (in migraine with aura) were more often fulfilled by children. Accordingly, there are only a few differences concerning the fulfillment of the IHS criteria for migraine and tension-type headache in children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are most important for differentiating the two major types of idiopathic headache. The sensitivity of the IHS criteria for migraine could be increased by reducing the minimum duration of migraine and by allowing the diagnosis of migraine when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled.

Prevalences of primary headache symptoms at school-entry: a population-based epidemiological survey of preschool children in Germany

“…When reimplementing resulting descriptive classification rules to clinical practice, the paediatrist, for example, in his attempt to diagnose the observed pain symptoms of a certain child at a given time, meets problems, which have been described earlier [8,11,28,[30][31][32]. Additionally, results from epidemiological studies of headache and abdominal pain vary not only due to differences between study populations, methods, diagnostic criteria and their interpretations, but also because pain symptoms show extremely diverse interindividual variations over time [27][28][29][30][31][32][33][34]. According to Sillanpää and Abu-Arafeh [11], problems in defining and classifying primary headache in children proliferate because the clinical phenomenology is not always clear enough and sometimes overlaps.…”

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.…”

“…4,8,11 Most of these combinations included the pain characteristics. Of all associated symptoms, only nausea was included in combinations that significantly increased migraine risk.…”

“…11 The analysis of the different combinations of the items included in the diagnostic criteria C and D for TTH showed that the combination in criterion С "bilateral location, pressing-tightening quality, mild intensity, no pain aggravation by physical activity" had 100% specifi city and made the diagnosis TTH certain. That is why we could recommend this combination of symptoms as diagnostic for TTH, independently of the other headache characteristics.…”

“…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.…”