Diagnosis of Headache in Childhood and Adolescence: A Study in 437 Patients

Abstract

We investigated whether the criteria for idiopathic headache published by the International Headache Society (IHS) are useful in childhood and adolescence and compared the diagnoses according to this classification with those of Vahlquist. We used a semi-structured questionnaire to examine a total of 437 children and adolescents referred consecutively to a headache outpatient clinic. Twenty-eight of 437 patients were excluded because of symptomatic or unclassifiable headache. Of 409 patients with idiopathic headache, 70.4% had definite migraine or tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder (IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria (IHS 2.3). In the differential diagnosis of migraine and tension-type headache the intensity of pain, aggravation of headache by physical activity, nausea and vomiting were the most important features. The quality of pain, photo- and phonophobia were less helpful and location least important. The duration of migraine attacks was less than 2 h in 19.0% of the migraine patients. In general, the diagnostic criteria of migraine were highly specific but less sensitive, and those of tension-type headache highly sensitive but less specific. The agreement between IHS criteria and those of Vahlquist was marked (kappa = 0.57). We conclude that the IHS criteria are useful for classifying headache in children and adolescents referred to a headache outpatient clinic. A forthcoming modification of the IHS criteria should consider a reduction of the minimum duration of migraine attacks from 2 h to 1 h and should try to increase the sensitivity of the criteria for migraine and the specificity of the criteria for tension-type headache.

Recurrent and chronic headaches in children below 6 years of age

“…The high rate of positive family history for migraine was consistent with Chu and Shinnar's study [10]. Nausea is less present than other neurovegetative signs in comparison with the school children and adolescents [18], probably because of children's incapability of describing this symptom.…”

“…These data are hard to compare with other studies in this age because there are no studies that describe in a clear fashion the features of ETH in children at this age [19]. In two clinical-based studies [18,20] in school paediatric age the duration of headaches was reported more than in our data and there was more prevalence of associated symptoms and pulsatility. However, the duration of pain was the main limiting factor to classify the ETH according to the IHS criteria.…”

Specific Triggers of Migraine Headache in Adolescents

“…Wober Bingol's [18] Population Study encountered prevalence of 3-17.6 % of migraine in adolescents. Describing pediatric headache, as a common health problem, Hershey found migraine in 10.6% of children between the age of 5 and 15 and in up to 28% of adolescents between the ages of 15 and 19 [19].…”

Specific features of migraine syndrome in children

“…In 2.7% children aged 7 years and 10.6% children aged 14 years he defined migraine using Vahlquist's criteria [10]. Wöber-Bingöl et al's population study of migraine in children and adolescents [11] encountered migraine prevalence of 1.1%-5% in children and 3%-17.6% in adolescents. Zencir et al [12] found overall migraine prevalence was 8.8%; it was 6.7% in boys and 11.0% in girls (OR: 1.7; 95% CI: 1.3-2.3).…”

“…Analysing 409 children, Wöber-Bingöl et al [16] found the duration of migraine attacks was less than 2 h in 19.0% of migraine patients.…”