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Pediatric migraine and the International Headache Society (IHS) criteria
J Maytal1, M Young, A Shechter
1Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.
Insights
The International Headache Society (IHS) criteria for diagnosing pediatric migraine without aura show low sensitivity but high specificity. Modifications are needed to better align with clinical practice in children.
Area of Science:
- Pediatric Neurology
- Headache Medicine
- Clinical Diagnostics
Background:
- Diagnostic criteria for migraine without aura in children lack consensus.
- Comparing diagnostic criteria against expert clinical judgment is a key validation strategy.
Purpose of the Study:
- To assess the agreement between pediatric neurologist diagnoses and International Headache Society (IHS) criteria for migraine without aura in children.
- To evaluate alternative symptom-based case definitions against expert clinical diagnoses.
Main Methods:
- Retrospective review of 253 pediatric patients evaluated at a specialized headache unit.
- Clinical diagnoses by pediatric neurologists served as the gold standard.
- International Headache Society (IHS) criteria and alternative definitions were compared to the gold standard.
Main Results:
- The IHS criteria demonstrated low sensitivity (27.3%) but high specificity (92.4%) for diagnosing migraine without aura in children.
- Key IHS features like prolonged duration, unilateral pain, vomiting, and phonophobia were infrequent in clinically diagnosed pediatric migraines.
- A proposed alternative definition showed improved sensitivity (71.6%) with comparable specificity.
Conclusions:
- The current IHS criteria for pediatric migraine without aura exhibit poor sensitivity when validated against expert clinical diagnosis.
- Significant modifications to the IHS criteria are recommended to improve their clinical utility and accuracy in pediatric populations.
Background:
The optimal criteria for the diagnosis of migraine without aura in children are controversial. One strategy for assessing the validity of diagnostic criteria is to compare them with expert clinical diagnoses.
Objective:
To study the agreement between clinical headache diagnoses assigned by pediatric neurologists and symptom-based diagnoses using the International Headache Society (IHS) criteria as well as alternative case definitions.
Methods:
We reviewed the records of 253 children and adolescents consecutively evaluated by pediatric neurologists at the Montefiore Headache Unit. Clinical diagnoses assigned by the physicians were used as the gold standard in evaluating the validity of the IHS criteria for the diagnosis of migraine without aura. Alternative symptom-based diagnoses were compared with the clinical gold standard.
Results:
Detailed headache histories were abstracted from charts of 253 children; 167 children had complete data on all features required for IHS diagnosis. Eighty-eight (52.7%) children received a diagnosis of migraine without aura. Using the clinical diagnosis as the gold standard, the IHS criteria had a sensitivity of 27.3% and a specificity of 92.4%. The poor sensitivity of the IHS definition is a consequence of the rarity of certain features in children clinically diagnosed with migraine: duration of 2 hours or longer (55.7%), unilateral pain (34.1%), vomiting (47.7%), and phonophobia (27.3%). Based on these findings we suggested a definition for pediatric migraine headache without aura that is less complex, more sensitive (71.6%), and almost as specific as the IHS criteria.
Conclusions:
The IHS criteria for migraine without aura have poor sensitivity but high specificity using a clinical diagnosis as the gold standard. The IHS criteria should be modified to better reflect current pediatric clinical practice.