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Published on: June 2, 2014
Diagnosis of migraine in children attending a pediatric headache clinic
T J deGrauw1, A D Hershey, S W Powers
1Division of Neurology, Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
Insights
The International Headache Society (IHS) criteria need revision for diagnosing pediatric migraine. Current criteria for headache duration and localization are insufficient for children, impacting accurate diagnosis.
Area of Science:
- Neurology
- Pediatrics
- Headache Medicine
Background:
- The International Headache Society (IHS) criteria are the standard for diagnosing migraine.
- Pediatric migraine presents differently than adult migraine, particularly regarding headache duration and localization.
- Existing IHS criteria may not adequately capture migraine diagnoses in children.
Purpose of the Study:
- To evaluate the sufficiency of current IHS criteria for diagnosing migraine in individuals under 18.
- To compare the formal IHS criteria with modified versions and older diagnostic standards.
- To determine optimal criteria for pediatric migraine diagnosis.
Main Methods:
- Comparison of formal IHS criteria with pediatric-amended IHS criteria.
- Analysis of IHS criteria with the duration factor removed in children.
- Evaluation of older criteria (Vahlquist, Prensky, and Sommer).
- Comparison of clinical diagnosis with IHS criteria excluding duration.
Main Results:
- Many children with shorter headache durations meet migraine criteria.
- Some children with very long headache durations also meet migraine criteria.
- Unilateral headaches are uncommon in pediatric migraine; bilateral headaches are more prevalent.
- Current IHS criteria appear insufficient for accurate pediatric migraine diagnosis.
Conclusions:
- The IHS criteria for pediatric migraine require revision.
- Consider making headache duration a minor criterion for pediatric migraine.
- Suggest excluding headaches >72 hours only for children under 15 years.
Abstract:
The International Headache Society (IHS) criteria for migraine are not sufficient to diagnose migraine in children. Specifically, the duration and localization of the headache are different in children and adults with migraine. This study compared the formal IHS criteria with pediatric-amended IHS criteria and IHS criteria with the duration factor removed in children younger than 18 years. In addition, the older criteria by Vahlquist and by Prensky and Sommer were also compared. Finally, clinical diagnosis of migraine was compared with IHS criteria with the duration factor removed. The study showed that many children with a shorter duration headache have migraine and also that a number of children with a very long duration of headaches still fit the diagnosis of migraine. Unilateral headache is quite uncommon. The majority of children with migraine complained of bilateral headaches. It is concluded that the IHS criteria for pediatric migraine should be revised. We suggest making the duration factor a minor criteria for migraine in children or to exclude headaches lasting longer than 72 hours only in children younger than 15 years.
