Validity of the International Headache Society Criteria for Migraine

Abstract

For general practitioners and in epidemiological studies, migraine poses diagnostic problems. It is a polymorphous disease, with diagnosis based on a subjective description of symptoms. The International Headache Society (IHS) proposed a set of rigorous criteria for the diagnosis of migraine. We studied its validity on 171 outpatients of headache clinics and on 96 headache sufferers detected during an annual checkup for workers. The criteria showed an excellent specificity, however sensitivity in both samples was <50%. This lack of validity could be due to IHS criteria being too restrictive. We therefore elaborated and validated our own diagnostic tool, based on the IHS criteria, to a sensitivity of 95% and a specificity of 78%. We propose our tool for epidemiological studies.

Prevalence and clinical characteristics of migraine in France

“…12,13 Although overall prevalence, age and sex distribution, and frequency * These data are presented for the subpopulation of subjects who had taken medication to treat their last attack. and duration of migraine attacks are comparable to what they were 10 years ago, 4 there may have been a change in perceived pain intensity. In 1989, 74% of subjects reported severe or very severe pain, whereas in the current study this proportion has fallen to 62.5%.…”

“…Using the algorithm described in our 1990 study, the diagnostic accuracy of the combined migraine (IHS categories 1.1 and 1.2) and borderline migraine groups (which is more restrictive than IHS criterion 1.7) was validated against clinical diagnosis of migraine by French neurologists. 4 It was found that the sensitivity of diagnosis was 95%, but that specificity was reduced from 91.9 to 78.4% compared with IHS criteria 1.1 and 1.2. However, using identical diagnostic criteria, the prevalence of migraine in France appears to have been stable over the past 10 years.…”

“…4,18,19 The data show the percentage of individuals in the total migraine population (migraine 1.1/1.2 ϩ migrainous disorder; n ϭ 880) who identified the indicated prognostic factor out of a list of 45 potential factors. More than one response was allowed.…”

“…We found a prevalence rate of 8.1% for migraine. We also characterized a second group called borderline migraine, which was defined operationally and validated against standard neurologists' diagnosis in France, 4 with a prevalence rate of 4.0%. Therefore, the total migraine prevalence was 12.1% (17.6% in women and 6.1% in men).…”

Chronic daily headache: When to suspect sinus disease

“…The IHS does not consider CRS a valid cause of facial pain or headache, yet many cases of "sinus headache" are thought to represent undiagnosed migraine because they satisfy IHS criteria [12•]. Multiple studies have cast doubt as to the validity of using IHS criteria as a gold standard to diagnose migraine, rather than physician evaluation [13][14][15]. In fact, many nonmigraine episodes (eg, head trauma) can qualify for at least a migrainous episode per IHS criteria until actual physician assessment is made [16•].…”