Use of Cluster Analysis to Validate IHS Diagnostic Criteria for Migraine and Tension‐Type Headache

Abstract

Cluster analysis was used to validate headache diagnostic criteria of the International Headache Society (IHS). Structured diagnostic interviews were conducted on 443 headache sufferers from a community sample, which was randomly split to allow replication. Hierarchical cluster analysis of symptoms in both subsamples revealed two distinct (P<.001) clusters: (1) unilateral pulsating pain, pain aggravated by activity, and photophobia and phonophobia, and (2) bilateral pressing/tightening pain, mild to moderate intensity, and absence of nausea/vomiting. These clusters were consistent with IHS migraine and tension-type classifications, respectively. Replication using a non-hierarchical clustering technique, k-means cluster analysis, revealed a migrainelike patient cluster, reflecting more frequent pulsating, unilateral pain; more severe pain; and pain aggravated by activity; nausea, vomiting, photophobia, and phonophobia. A tensionlike patient cluster was also identified, reflecting more frequent pressing/tightening pain, mild to moderate pain, bilateral location, and absence of nausea/vomiting. These patient clusters were consistent across subsamples. International Headache Society diagnoses corresponded with classification based upon statistically derived clusters (P<.001). These results indicate that headache symptoms cluster empirically in a manner consistent with IHS criteria for migraine and tension-type headaches. Criterion overlap problems regarding pain intensity and duration were identified. Overall, these data support migraine and tension-type headache as distinct entities, and provide support for the IHS diagnostic criteria with minor modifications.

Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood

“…This structured interview was modeled after the interview used in previously published work by the last author and others that was designed to facilitate headache diagnosis by trained non-physicians using the previous version of the IHS diagnostic criteria [4,8]. Respondents answer a series of standard questions followed by open-ended probes that elicit further information regarding the quality, duration, frequency, and other characteristics of each type of headache reported by the respondent.…”

“…At follow-up, we assessed participants’ reports of symptoms associated with the Rome III criteria for abdominal pain-related FGIDs in adults [12], symptoms associated with the International Headache Society criteria for headaches [8], and the presence of chronic pain at multiple body locations. We hypothesized that pediatric patients with FAP that persisted into adulthood would have a significantly higher prevalence of comorbid chronic pain and headache as adults compared to patients in the Resolved FAP group and controls without a childhood history of FAP.…”

Changes of Meningeal Excitability Mediated by Corticotrigeminal Networks: A Link for the Endogenous Modulation of Migraine Pain

“…In accordance with this view, the perception of visual aura is predominantly contralateral to the pain, as expected if CSD activates only the trigeminovascular system through adjacent pial nociceptors. From the clinical point of view, however, epidemiological studies have shown that 40% of migraine patients also experience bilateral headaches (Rasmussen et al, 1991) and that the headache location appears to have little specificity or diagnostic utility (Bruehl et al, 1999). Other clinical studies have documented ipsilateral visual aura and headache in some migraine patients who experience aura, simultaneous aura at the onset of pain, or even aura without pain (Pietrobon and Striessnig, 2003 and references therein).…”

Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache

“…For each of the nosological classifications to date, the differential diagnosis between migraine and TTH is entirely a function of differing self-reported symptom typologies. They nevertheless presuppose fundamentally different pathophysiologies underlie each of the primary disorders that, in turn, indicate differing treatment approaches [6,41]. …”

“…The conceptualization of migraine and TTH as distinct phenomena has not gone unchallenged [6,20,40,43]. An alternative perspective— the continuum severity model—holds that these headache ‘types’ instead represent points on a single continuum of severity, with migraine falling at the more severe end of the symptom spectrum [4,10,27,30,48,56] Findings from a latent class analysis of migraine have indicated a severity continuum among patients with and without aura [34].…”