PEDIATRIC MIGRAINE AND THE INTERNATIONAL-HEADACHE-SOCIETY (IHS) CRITERIA

Background: The optimal criteria for the diagnosis of migraine without aura in children are controversial, One strategy for assessing the va lidity 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 diagno ses using the International Headache Society (MS) criteria as well as alternative case definitions, Methods: We reviewed the records of 253 children and adolescents consecutively evaluated by pediatric neurolog ists at the Montefiore Headache Unit. Clinical diagnoses assigned by t he physicians were used as the gold standard in evaluating the validit y of the MS criteria for the diagnosis of migraine without aura. Alter native symptom-based diagnoses were compared with the clinical gold st andard. Results: Detailed headache histories were abstracted from char ts of 253 children; 167 children had complete data on all features req uired for IHS diagnosis. Eighty-eight (52.7%) children received a diag nosis of migraine without aura, Using the clinical diagnosis as the go ld standard, the IHS criteria had a sensitivity of 27.3% and a specifi city of 92.4%, The poor sensitivity of the IHS definition is a consequ ence of the rarity of certain features in children clinically diagnose d with migraine: duration of 2 hours or longer (55.7%), unilateral pai n (34.1%), vomiting (47.7%), and phonophobia (27.3%). Based on these f indings we suggested a definition for pediatric migraine headache with out aura that is less complex,more sensitive (71.6%), and almost as sp ecific as the II-IS criteria. Conclusions: The IHS criteria for migrai ne without aura have poor sensitivity but high specificity using a cli nical diagnosis as the gold standard, The MS criteria should be modifi ed to better reflect current pediatric clinical practice.