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Published on: June 2, 2014
Diagnosis of migraine in the pediatric emergency department
Evelyne D Trottier1, Benoit Bailey, Nathalie Lucas
1Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec.
Insights
Pediatric emergency physicians
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Headache Disorders
Background:
- Current migraine diagnostic criteria have limited sensitivity in pediatric populations.
- Existing criteria are not optimized for emergency department (ED) settings.
- Accurate migraine diagnosis in children presenting to the ED is challenging.
Purpose of the Study:
- To compare the diagnostic accuracy of pediatric emergency physicians' clinical judgment against established and novel migraine criteria in children.
- To evaluate the International Classification of Headache Disorders II (ICHD-II) criteria (annotated for children) and the Irma emergency department criteria.
- To establish a neurologist's diagnosis as the gold standard for comparison.
Main Methods:
- Prospective study of pediatric patients (<18 years) with moderate to severe headaches treated in the ED.
- Data collected via standardized questionnaires completed by patients/families.
- Neurological assessment within 3 months to confirm diagnosis.
Main Results:
- Of 79 children, 64 (94%) had confirmed migraine diagnoses.
- The Irma criteria identified 55 (86%) of pediatric migraine cases.
- The ICHD-II criteria identified only 29 (45%) of pediatric migraine cases.
Conclusions:
- Pediatric emergency physicians' clinical judgment demonstrated superior sensitivity for diagnosing migraine in children compared to existing criteria.
- Published migraine criteria, including ICHD-II, lack sufficient sensitivity for effective use by pediatric emergency physicians.
- The Irma emergency department criteria showed improved sensitivity over ICHD-II but still lagged behind physician judgment.
Background:
Migraine criteria lack sensitivity in children and are not designed to be used in the emergency department. This study's aim was to compare the diagnosis of migraine in children with moderate to severe headache made by pediatric emergency physicians to the International Classification of Headache Disorders II migraine criteria with annotation for children and a new criteria, the Irma emergency department criteria, using the neurologist's diagnosis as the gold standard.
Methods:
This was part of a prospective study with a convenience sample of patients <18 years old, diagnosed with migraine by pediatric emergency physicians and treated with intravenous medication due to severity of symptoms. A standardized questionnaire on the patient's present and past headaches description was completed by the patient and his or her family during their stay in the emergency department. Each patient was assessed by a pediatric neurologist within 3 months to confirm the final diagnosis.
Results:
Between July 2007 and July 2009, 79 children completed a questionnaire. Of these, 11 were not evaluated by the neurologist (eight never reported for follow-up and three were not referred). Of the remaining, four had another final diagnosis, leaving 64 (94%) patients with confirmed diagnoses of migraine. Among these patients, 29 (45%) had headaches that fulfilled the International Classification of Headache Disorders II migraine criteria with annotation for children and 55 (86%) fulfilled the new criteria, the Irma emergency department criteria.
Conclusions:
Physicians' clinical judgment performed better than the published migraine criteria, which did not have adequate sensitivity to be of use to pediatric emergency physicians.
