MIGRAINE IN CHILDHOOD AND ADOLESCENCE - A CRITICAL-STUDY OF THE DIAGNOSTIC-CRITERIA AND OF THE INFLUENCE OF AGE ON CLINICAL FINDINGS

We studied 253 children aged <15 years. Phase 1 included 193 children with migraine (1.1 and 1.2) divided into two groups (<10 and greater t han or equal to 10 years). We studied the relationship between age and migraine type, headache characteristics, and associated symptoms of t he International Headache Society (MS) definition. A higher frequency of migraine with aura, pulsatile quality, and unilateral location was observed in older children. In phase 2 we studied 176 children with he adache (excluding migraine with aura), comparing diagnostic criteria, definition items, sensitivity, and specificity. The results showed tha t item B of the definition was the most frequent cause of exclusion in the 1.7 diagnostic group. Compared with Vahlquist and the MS, the Pre nsky criteria were the most sensitive. Sensitivity was >70% for pain o f moderate/ severe intensity, duration between 2 and 48 h, isolated ph otophobia, isolated phonophobia, and aggravation with physical activit y. Specificity was >70% for nausea, vomiting, phonophobia and photopho bia, isolated photophobia, aggravation with physical activity, and iso lated phonophobia. Based on three alternative definitions, each modify ing one item of the MS definition, the sensitivity and specificity of these alternative definitions were compared with the ''extended'' crit eria (children with migraine without aura and migrainous disturbance, according to the MS criteria, grouped together). Exclusion of headache duration increased sensitivity by 10%, compared to restrictive MS cri teria, without decreasing specificity.