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

Abstract

The objective of this study was to assess whether migraine and tension-type headache (TTH) are best viewed as discrete entities or points on a severity continuum using taxometric analysis. Historically, classification systems have conceptualized the primary headache disorders of migraine and TTH as fundamentally different disorders that are differentiated by their characteristic symptom profiles and, as such, imply differing pathophysiologies and required treatments. Despite this categorical nosology, findings continue to emerge suggesting that migraine and TTH instead reflect dimensions of severity within the same headache construct. However, few studies have assessed this issue using taxometric statistical analyses or investigated how this taxonomic structure varies as a function of age and headache frequency. We conducted a latent-mode factor analysis of headache symptomatology obtained from 3449 individuals with headache from 2 previous, large-scale cross-sectional studies of primary headache sufferers (Martin et al., 2005, and Smitherman and Kolivas, 2013). Stratified taxometric analyses suggest that the validity of a categorical vs dimensional classification varies as a function of sample characteristics. Specifically, graphical results revealed that high headache frequency (≥ 15 d/mo) and younger age (≤ 24 years old) were associated with unimodal distributions suggestive of a dimensional construct of primary headache, whereas lower headache frequency and older age were associated with bimodal distributions characteristic of discrete diagnostic entities. Conceptualizing primary headache as a severity continuum was supported for young adults and those with frequent headaches. The distinctions of a categorical classification system were supported for adults (> 24 years old) and those with infrequent headache.

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

“…Pediatric data supports the notion that childhood headaches are a continuum, rather than discrete entities [46,47]. Recent findings [48] suggest that “migraine” and “tension-type” headaches might not be separate diagnostic/disease entities, but rather represent a severity continuum for young adults 18–24 years of age who experience chronic headaches more than 3–4 days per week. Two cross-sectional studies [48] with more than 3400 headache patients revealed that those who are experiencing headaches at a younger age (18–24 years old) and with higher frequency (more than 15 headache days/month) displayed a unimodal distribution, suggesting the dimensional construct of a primary headache.…”

“…Recent findings [48] suggest that “migraine” and “tension-type” headaches might not be separate diagnostic/disease entities, but rather represent a severity continuum for young adults 18–24 years of age who experience chronic headaches more than 3–4 days per week. Two cross-sectional studies [48] with more than 3400 headache patients revealed that those who are experiencing headaches at a younger age (18–24 years old) and with higher frequency (more than 15 headache days/month) displayed a unimodal distribution, suggesting the dimensional construct of a primary headache. Conversely, patients who experienced a lower frequency of headaches and were of older age showed bimodal headache distributions, which could be differentiated into “migraine” versus “tension-type” headache.…”

Visual Field Losses in Patients with Migraine without Aura and Tension-Type Headache

“…Diagnostic distinction between these two common headache types is not readily apparent in patients with chronic headaches and of young age. 28 To our knowledge, this is the first study demonstrating that patients with TTH show some visual field deficits like migraineurs. In our study, field loss was 44% and 36% in migraineurs and TTH patients, respectively.…”

“…Turner et al showed in their taxometric analysis study that diagnostic/symptomatic distinctions between headache types would be less prominent among individuals with frequent headaches and those of younger age. 28 Migraine and TTH are differentiated by their characteristic symptoms and as such imply differing pathophysiologies and required treatments. Despite this categorical nosology, findings continue to emerge suggesting that migraine and TTH instead reflect dimensions of severity within the same headache construct.…”

Development and Validation of a Four‐Item Migraine Screening Algorithm Among a Nonclinical Sample: The Migraine‐4

“…Participants were young adults at a southeastern university who participated voluntarily in exchange for modest course credit. As part of an ongoing data collection effort, from August 2012 to December 2013 they completed an online battery of measures, including a computer‐administered structured diagnostic interview for headache. Those meeting ICHD‐3 beta criteria for EM (with or without aura) or chronic migraine comprised the migraine group.…”