International Headache Society Criteria and Childhood Headache

Abstract

SUMMARY The objective of this study was to determine whether the intuitive clinical diagnosis of a headache type made by paediatric neurologists would also have fulfilled International Headache Society (IHS) criteria for that type. Clinical information was recorded on data sheets. The neurologists made clinical diagnoses without referring to a fixed set of criteria. An independent physician then used the information on the data sheets to classify the child's headache by IHS criteria. Complete data sheets were available for 72 children, aged between four and 18 years. The intuitive clinical diagnosis was completely concordant with the criterion diagnosis of the IHS in 61 per cent, partially concordant in 31 per cent and at complete variance in 8 per cent. These data suggest that the IHS criteria can be applied to a majority of children in a referral‐based population such as this, but that minor revisions to the criteria are necessary to make them even more applicable to children. RÉSUMÉ Critères de ľInternational Headache Society et maux de têle chez ľenfant Ľobjectif de cette étude était de déterminer si le diagnostic clinique intuitif du type de maux de tête effectué par les neuro‐pédiatres remplissait les critères de ľlnternational Headache Society (IHS) pour chaque type. Les informations cliniques étaient recueillies sur des feuilles de données. Les neurologues portaient un diagnostic sans référence à un ensemble donne de critères. Un médecin indépendant utilisait alors les feuilles de donnees pour classer les maux de tête de chaque enfant selon les critères de PIHS. Des feuilles de données complètes furent obtenues pour 72 enfants âgés de quatre à 18 ans. Le diagnostic clinique intuitif était totalement concordant avec les critères diagnostiques de ľIHS dans 61 pour cent des cas, partiellement concordant dans 31 pour cent des cas et differait totalement dans 8 pour cent. Ces données suggèrent que les critères IHS peuvent être appliqués à la majorité des enfants dans une population de même référence, mais que des révisions mineures des critères sont souhaitables pour en favoriser ľapplication aux enfants. ZUSAMMENFASSUNG Kriterien der Internalionalen Migränegesellsehaft und Kopfschmerz im Kindesalter Es war das Ziel dieser Studie, festzustellen, ob die intuitive klinische Diagnose eines Kopfschmer/typs durch einen Neuropädiater die Kriterien der Internalionalen Migränegesellsehaft (IHS) für diesen Typ erfüllt. Die klinischen Informationen wurden auf Formblätter übertragen. Die Neurologen stellten klinische Diagnosen, ohne sich an vorgeschriebene Kriterien zu halten. Ein unparteiischer Arzt klassifizierte dann die Daten auf den Formblättern nach den IHS Kriterien. Von 72 Kindern im Alter zwischen vier und 18 Jahren lagen vollständige Formblätter vor. Die intuitive klinische Diagnose stimmte in 61 Pròzent ganz und in 31 Prozent teilweise mit den IHS Kriterien uberein und war in acht Prozent ganz anders. Diese Daten zeigen, daß die IHS Kriterien auch bei der Mehrzahl der Kindern anwendbar sind, dafi aber kleine...

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

“…5,22 For the evaluation of episode intensity, this study shows that behaviour during attacks is a more appropriate measure than pain score, especially for the youngest children; in fact, pain score could not be provided by many children, especially the youngest. In a previous report, 15 behaviour during episodes was found to be a valid measure of intensity compared with a clinician's impression.…”

Diagnosing migraine in the pediatric population

“…In addition, young children and their parents may not be able to describe the pain or the associated features of the attacks in the terms required by the IHS criteria. For example, in their specialty center-based study, Seshia et al [9] found that in children with headaches, 30% could not describe the quality of their pain and 16% could not report on photophobia and phonophobia. Inability to report migraine-defining features may lead to underdiagnosis using strict IHS criteria.…”

“…The utility of the IHS criteria for pediatric headache disorders has been challenged primarily because expert clinical diagnosis and IHS-based diagnosis often disagree. Reported levels of agreement have ranged from 44% to 66% [5][6][7]9,28,29]. For example, Seshia et al [9] examined a specialty referral sample of 77 children (median age 11 years).…”

“…Reported levels of agreement have ranged from 44% to 66% [5][6][7]9,28,29]. For example, Seshia et al [9] examined a specialty referral sample of 77 children (median age 11 years). They found full agreement between clinical and IHS diagnosis in 44 children (61%), partial agreement in 22 children (31%), and complete lack of agreement in six children (8%).…”

“…A series of studies on the diagnosis of headache in children and adolescents provides an empiric basis for recommending revisions to the ICHD-II criteria for migraine in the pediatric population [1,2••, [3][4][5][6][7][8][9][10][11]. Continued revisions and emerging new criteria should provide important tools for clinical practice, clinical trials, and epidemiologic research.…”