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.