Migraine in Childhood and Adolescence. A Critical Study of the Diagnostic Criteria and of the Influence of Age on Clinical Findings

Abstract

ABSTRACT)*. THESIS. SÃO PAULO, 1998. JOSÉ LUIZ DIAS GHERPELLI **Two hundred and fifty-three children, aged < 15 years old, comprised the study group. The study was divided in 2 phases.Phase 1 included 193 children with migraine with and without aura (1.1 and 1.2) diagnosed according to the IHS criteria, with a mean age of 10,3 y., divided in 2 groups according to their age (< 10 or > 10 years). We studied the relationship between age and migraine type, headache characteristics and associated symptoms that are part of the IHS definition. Results showed a statistically significant higher frequency of migraine with aura in children > 10 years old (p = 0.0002) compared to those with < 10 years; nonparametric statistical analysis showed a significant relation between older age and increase in migraine with aura frequency (p = 0.0003). Pulsatile quality and unilateral pain location were also related to age, being more frequent in older children (p = 0.02 and p = 0.01, respectively).Phase 2 studied 176 children with headache (1.1, 1.7, 2.1, 2.2, 4), excluding those with migraine with aura. The objectives were to: 1. analyze which of the IHS definition items were responsible for the children's exclusion of the migraine (1.1) diagnosis; 2. study the concordance degree between the restrictive IHS criteria, Prensky and Vahlquist criteria, compared to an "extended" criteria used as a "gold standard", that included the non-classified children in the migraine group; 3. study the degree of sensitivity and specificity for each of the definition items of the IHS definition and; 4. analyze alternative definitions, based on the restrictive IHS definition, which could improve the sensitivity concerning the children of the 1.7 diagnostic group. The results showed that item B of the definition was the most frequent cause of exclusion in the 1.7 diagnostic group, compared to items C and D (all children fulfilled item A). Prensky criteria showed the highest sensitivity, compared to the Vahlquist and IHS, although all three criteria showed sensitivity over 70%. Headache characteristics and associated symptoms that showed sensitivity over 70%, in decreasing order of frequency, were: pain of moderate/severe intensity, pain duration between 2 to 48 hours, isolated photophobia, isolated phonophobia and aggravation with physical activity. Headache characteristics and associated symptoms that showed specificity over 70%, in decreasing order of frequency, were: nausea, vomiting, phonophobia and photophobia (all 3 with 100%), isolated photophobia, aggravation with physical activity and isolated phonophobia. Based on 3 alternative definitions, each of them modifying one item of the IHS definition (with the exception of item A), while maintaining the others unchanged, we compared the sensitivity and specificity of these alternative definitions with the "extended" criteria. We observed that the exclusion of item B led to a 10% increase of sensitivity compared to the restrictive IHS, without losing specificity.We concluded that item B of the IHS cr...

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

“…The children attended a specialized headache clinic in Milan, where there is usually little selection of children with the more severe forms. They had a similar percentage of severe or moderate intensity to that described in another study of children with primary headaches with the same mean age, 4 although they had lower percentages of the characteristics typical for migraine. Few studies have analysed the use of the ICHD-II for classification of children with headaches.…”

“…The modification of the duration criterion, namely acceptance of 1-hour duration for MO (independently of corroboration by diary), as most authors suggest, [3][4][5][6][7][8][9][10][11] resulted in the children in our study showing a statistically non-significant increase in the number with MO as a result of a decrease in the number with probable MO, compared with the results of the ICHD-II, but not in a decrease in unclassifiable children. Following the above-mentioned change for the duration criterion, other authors have reported an increase of migraine cases without making a distinction between MO and probable MO.…”

“…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. 3,9 Some authors have suggested elimination of the duration criterion for MO 4,12,13 or for TTH. 12 In one study, it was also found that the number of precipitating factors is higher in MO than in TTH, and this characteristic was suggested as a classification criterion.…”

Prevalence of Headache in Swedish Schoolchildren, with a Focus on Tension-Type Headache

“…No modification has been made for the number of earlier episodes (criterion A). Several authors have suggested a further shortening (12,13,(15)(16)(17)(18)(19)(20)(21) or even exclusion (22,23) of the duration criterion for migraine in children. In addition, the requirement of five earlier episodes of migraine in a childhood population has been questioned (15).…”

Brief migraine episodes in children and adolescents-a modification to International Headache Society pediatric migraine (without aura) diagnostic criteria

“…Similarly Metsahonkala ( 1994 ) reported that when duration was omitted as a criterion the prevalence of migraine increased by 25.9%. In fact Gherpelli and colleagues ( 1998 ) found that entirely excluding duration criterion increased the sensitivity without decreasing the specificity of pediatric migraine diagnosis. This study supports the suggestion of decreasing the criterion on the minimal duration of head pain to less than one hour for migraine without aura in children.…”