Migraine without aura and migrainous disorder in children; International Headache Society (IHS) and revised IHS criteria

Serotonin has long been implicated as a key neurotransmitter in migraine. There is a dearth of research specifically examining 5-HT1A receptor sensitivity in migraine despite the importance of this receptor in regulating central serotonergic tone. In this study we examined the hypothesis that migraine without aura is associated with hypersensitivity of central 5-HT1A receptors, using a 5-HT1A neuroendocrine challenge drug and comparing serum prolactin responses between a test group with migraine and a matched group of healthy controls. Twelve female subjects fulfilling International Headache Society (IHS) criteria for migraine without aura were evaluated. Following an overnight fast, subjects presented for testing at 9am. An intravenous canula was inserted and serum prolactin was assessed at baseline and every 30 min for 3 h following a single dose of 30 mg oral buspirone, a 5-HT1A-receptor agonist. Subjects were assessed during the first 5 days of the menstrual cycle. No subjects were taking psychotropic medication or migraine prophylactic treatment. Patients with current or previous psychiatric disorder, daily headache or analgesic overuse were excluded. 16 healthy female volunteers matched for age and menstrual status were also evaluated and served as controls. There was no difference in baseline prolactin between groups. There was a significant rise in prolactin following buspirone in both groups. Subjects with migraine had a significantly increased prolactin response to buspirone (delta max) compared to controls ( P < 0.001). This study supports the hypothesis that migraine without aura is associated with a relative hypersensitivity of central 5-HT1A receptors. This is of relevance given the role of the 5-HT1A receptor in controlling raphe 5-HT tone and in the possible association between migraine and anxiety and depression.

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Validation of diagnostic criteria for migraine in the Zürich longitudinal cohort study

Cephalalgia ◽

10.1177/0333102493013s1210 ◽

1993 ◽

Vol 13 (12_suppl) ◽

pp. 47-53 ◽

Cited By ~ 39

Author(s):

Kathleen Ries Merikangas ◽

Amy E Whitaker ◽

Jules Angst

Keyword(s):

Young Adults ◽

General Population ◽

Diagnostic Criteria ◽

Migraine Without Aura ◽

International Headache Society ◽

Gastrointestinal Symptoms ◽

Tension Type Headache ◽

Peak Period ◽

Systematic Assessment ◽

Ihs Criteria

This paper reports the results of a systematic assessment of the validity of the specific diagnostic criteria for migraine without aura, as defined by the International Headache Society (IHS), in a longitudinal epidemiologic sample of young adults who were selected from the general population of Zürich, Switzerland. Systematic modification of each of the IHS criteria for migraine without aura yielded one-year weighted prevalence rates ranging from 24% for the unmodified IHS criteria to 9% for the most restrictive definition of migraine. The major implications of the findings for the IHS criteria are: (a) they provide adequate coverage to classify the majority of subjects with headache in the general population; (b) there is little overlap between migraine and tension-type headache, suggesting that the criteria define moderately independent subgroups; (c) the criteria for migraine without aura appear to be too unrestrictive for application in the community, particularly among young adults at the peak period of incidence of migraine; (d) the criteria for “aura” need more precise operationalization; and (e) models of validation of the diagnostic criteria suggest that Criterion D of the IHS criteria for migraine without aura should be modified to require both gastrointestinal symptoms and photophobia and phonophobia.

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Post-traumatic headache

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000100011 ◽

2009 ◽

Vol 67 (1) ◽

pp. 43-45 ◽

Cited By ~ 15

Author(s):

Hugo André de Lima Martins ◽

Valdenilson Ribeiro Ribas ◽

Bianca Bastos Mazullo Martins ◽

Renata de Melo Guerra Ribas ◽

Marcelo Moraes Valença

Keyword(s):

Head Injury ◽

Migraine Without Aura ◽

International Headache Society ◽

Tension Type Headache ◽

Time Interval ◽

Mild Head Injury ◽

Ihs Classification ◽

Ihs Criteria ◽

Post Traumatic ◽

Type Headache

The onset of post-traumatic headache (PTC) occurs in the first seven days after trauma, according to the International Headache Society (IHS) classification. The objective of this study was to evaluate the several forms of headache that appear after mild head injury (HI) and time interval between the HI and the onset of pain. We evaluated 41 patients with diagnosis of mild HI following the IHS criteria. Migraine without aura and the chronic tension-type headache were the most prevalent groups, occurring in 16 (39%) and 14 (34.1%) patients respectively. The time interval between HI and the onset of headache was less than seven days in 20 patients (48.7%) and longer than 30 days in 10 (24.3%) patients. The results suggest that PTC may arise after a period longer than is accepted at the present by the IHS.

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Assessment of International Headache Society Diagnostic Criteria: A Reliability Study

Cephalalgia ◽

10.1046/j.1468-2982.1994.1404280.x ◽

1994 ◽

Vol 14 (4) ◽

pp. 280-284 ◽

Cited By ~ 45

Author(s):

M Leone ◽

G Filippini ◽

D D'Amico ◽

M Farinotti ◽

G Bussone

Keyword(s):

Diagnostic Criteria ◽

Medical Records ◽

Migraine Without Aura ◽

International Headache Society ◽

Tension Type Headache ◽

Kappa Statistics ◽

Reliability Study ◽

Ihs Criteria ◽

Craniofacial Pain ◽

Type Headache

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) “almost perfect” to “substantial” for the second digit migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the eria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced.

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Is Familial Hemiplegic Migraine a Hereditary form of Basilar Migraine?

Cephalalgia ◽

10.1046/j.1468-2982.1995.1506477.x ◽

1995 ◽

Vol 15 (6) ◽

pp. 477-481 ◽

Cited By ~ 49

Author(s):

J Haan ◽

GM Terwindt ◽

RA Ophoff ◽

PLJM Bos ◽

RR Frants ◽

...

Keyword(s):

Blood Flow ◽

Migraine Without Aura ◽

International Headache Society ◽

Familial Hemiplegic Migraine ◽

Control Group ◽

Artery Blood Flow ◽

Hemiplegic Migraine ◽

Ihs Criteria ◽

Genetically Determined ◽

Pathophysiologic Mechanisms

We studied aura symptoms in 83 patients from 6 unrelated families suffering from familial hemiplegic migraine. Fifty-five of the patients reported symptoms that allowed us to categorize them as basilar migraine (BM) patients, in accordance with the International Headache Society (IHS) criteria. In a control group of 33 patients suffering from migraine with aura and 33 patients suffering from migraine without aura, 9 patients complained of vertigo, and only one patient of diplopia during one of her attacks. None of these control patients fulfilled the IHS criteria for BM We suggest that familial hemiplegic migraine and BM may share certain pathophysiologic mechanisms, which may consist of a (genetically determined) disturbance of basilar artery blood flow.

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Migraine without aura and migrainous disorder in children; International Headache Society (IHS) and revised IHS criteria

Cephalalgia ◽

10.1111/j.1468-2982.2000.00103.x ◽

2000 ◽

Vol 20 (7) ◽

pp. 617-620 ◽

Cited By ~ 9

Author(s):

A Cano ◽

E Palomeras ◽

S Alfonso ◽

D Ortega ◽

P Sanz ◽

...

Keyword(s):

Prospective Study ◽

Migraine Without Aura ◽

International Headache Society ◽

Tension Headaches ◽

Ihs Criteria ◽

Increased Sensitivity ◽

Time Required ◽

A Prospective Study ◽

Headache Patients

The widely used criteria of the IHS to define migraine without aura in children are highly specific but show poor sensitivity, with a large percentage of headaches being classified as migrainous disorder (MD). The objective of this study was to assess how many headache patients in a series of children met the diagnostic criteria of the IHS for migraine without aura or MD and to determine the changes required to convert the greatest number of MD into migraine without aura, without affecting classification of the remaining headache types. A prospective study was undertaken of 131 patients under 15 years old referred to our centre for headache. Patients were classified according to the IHS criteria and according to a modification of these criteria consisting of: (1) reduction of minimum time required for classification into migraine without aura from 2 h to 1 h; (2) acceptance of bifrontal location in addition to hemicranial; (3) acceptance of either phonophobia or photophobia as valid criteria instead of requiring presence of both. Using the IHS criteria, 51 (39%) children were diagnosed as having migraine without aura and 26 (20%) as having MD. According to our revised IHS criteria, 68 (52%) were diagnosed as migraine without aura and nine (7%) as MD. When the three modified criteria were applied, three tension headaches and one unclassifiable headache changed category. When only reduced duration and bifrontal location were applied, none of the headaches other than MD changed category. Application of two modifications to the IHS criteria—reduction in duration of headache to 1 h and acceptance of bifrontal location—increased sensitivity without reducing specificity in classifying migraine without aura in children.

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Clinical Characteristics of Migraine in A Population-Based Twin Sample: Similarities and Differences Between Migraine with and Without Aura

Cephalalgia ◽

10.1046/j.1468-2982.1999.1903151.x ◽

1999 ◽

Vol 19 (3) ◽

pp. 151-158 ◽

Cited By ~ 16

Author(s):

M Kallela ◽

M Wessman ◽

M Färkkilä ◽

A Palotie ◽

M Koskenvuo ◽

...

Keyword(s):

Migraine With Aura ◽

Migraine Without Aura ◽

Clinical Characteristics ◽

Telephone Interview ◽

International Headache Society ◽

Epidemiological Data ◽

Population Based ◽

Unilateral Headache ◽

Chi Squared ◽

Similarities And Differences

Objective: To look into clinical differences between migraine with and without aura in a population-based sample of migraineurs. Background: Migraine presents in two major forms, migraine with and migraine without aura. With the exception of the aura phase, the clinical characteristics of these entities are very similar. Despite this, however, the recent epidemiological data underline differences between migraine with and without aura. We tried to examine whether other features besides the aura differ between these two major forms of migraine. Methods: We studied 321 twins suffering from migraine with aura and 166 twins with migraine without aura from the population-based Finnish Twin Cohort. Migraine was diagnosed according to the criteria of the International Headache Society (MS). Analysis was based on the combination of a mailed questionnaire and a telephone interview by a neurologist. Special attention was paid to differences between migraine with and without aura. Results: Some qualities of headaches differed between IHS defined migraine with and without aura. Unilateral headache (Chi-squared p=0.039) and photophobia (Chi-squared p=0.010) were more typical for migraine with aura, while nausea was more typical for migraine without aura (Chi-squared p=0.002). Duration of headache in migraine without aura was also longer man in migraine with aura (Mann-Whitney U-test 0.007). Conclusions: There are clinical differences between IHS defined migraine with and without aura; even the headache phase between the two entities differs. It is worthwhile distinguishing between them when looking for the elusive genes for these more common forms of migraine.

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Migraine and Glaucoma: an Epidemiologic Survey of French Ophthalmologists

Cephalalgia ◽

10.1046/j.1468-2982.1998.1802074.x ◽

1998 ◽

Vol 18 (2) ◽

pp. 74-76 ◽

Cited By ~ 23

Author(s):

A Pradalier ◽

P Hamard ◽

E Sellem ◽

L Bringer

Keyword(s):

Potential Role ◽

International Headache Society ◽

Tension Type Headache ◽

Epidemiologic Survey ◽

Migraine Prevalence ◽

Low Tension Glaucoma ◽

Ihs Criteria ◽

Type Headache ◽

Low Tension

Glaucoma is a common ocular disorder; a high intraocular pressure is observed in the majority of glaucoma (HIOPG) cases, but some patients have low-tension glaucoma (LTG). In the literature, some works link LTG and migraine, which is speculative of a potential role of a vasospastic factor or diathesis common to migraine and LTG. Using a standardized questionnaire based on International Headache Society (IHS) criteria, we investigated 954 glaucoma patients; 320 (33.5%) described a headache (migraine or tension-type headache) and 240 (25.1%) presented the IHS criteria for migraine. Migraine prevalence was not significantly different between HIOPG and LTG patients (22.8% and 32%, respectively) in this study.

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The Effect of Propranolol on Glyceryltrinitrate-Induced Headache and Arterial Response

Cephalalgia ◽

10.1111/j.1468-2982.2004.00796.x ◽

2004 ◽

Vol 24 (12) ◽

pp. 1076-1087 ◽

Cited By ~ 42

Author(s):

JF Tvedskov ◽

LL Thomsen ◽

HK Iversen ◽

P Williams ◽

...

Keyword(s):

Healthy Subjects ◽

Migraine Without Aura ◽

Rating Scale ◽

No Reduction ◽

International Headache Society ◽

Cerebral Arteries ◽

Superficial Temporal Artery ◽

New Drugs ◽

Prophylactic Effect ◽

Double Blind

Prophylactic drug trials in migraine are long-lasting and expensive and require long-term toxicology information. A human migraine model would therefore be helpful in testing new drugs. Immediate headache and delayed migraine after glyceryltrinitrate (GTN) has been well characterized. We have recently shown that sodium valproate has prophylactic effect in the GTN model. Here we report our experience with propranolol in this model. Nineteen subjects with migraine without aura and 16 sex- and aged-matched healthy subjects were included in a two-centre randomized double-blind cross-over study. Fourteen migraine subjects and 14 healthy subjects completed the study and results from comparison of the 28 subjects are reported. Randomly propranolol 160 mg or placebo were each given daily for 14 days to both migraine and healthy subjects. A 20-min intravenous infusion of GTN 0.25 mg/kg per min was administered on a study day at the end of both pretreatment periods. Headache was registered for 12 h after GTN infusions. Its intensity was scored on a numerical verbal rating scale from 0 to 10. Fulfilment of International Headache Society (HIS) criteria was recorded for 24 h. Radial and superficial temporal artery diameters and blood velocity of both middle cerebral arteries were measured. All migraine subjects developed headache after GTN. No reduction of overall peak headache was found after propranolol (median 5, range 0-7) compared with placebo (median 5, range 0-10) ( P = 0.441). Eight of the 14 completing migraine subject developed IHS 1.1 migraine after GTN, two subjects on both days, three subjects only after placebo, and three subjects only after propranolol. No reduction of GTN-induced migraine was found after propranolol compared with placebo (5 vs. 5, P = 1.000). All healthy subjects developed headache after GTN. No reduction of overall peak headache was found after propranolol (median 2, range 1-5) compared with placebo (median 1, range 1-7) ( P = 0.315). Two subjects fulfilled IHS criteria 1.1 for migraine without aura after propranolol but not after placebo. The fulfilment was short lasting and did not require rescue medication. Headache after GTN was more pronounced in migraine subjects than in healthy subjects both with ( P = 0.003) and without pretreatment with propranolol ( P = 0.017). We found that 2 weeks of propranolol constricted the radial artery in healthy subjects but not in migraine subjects. GTN-induced vasodilatation abolished this difference. Mean maximum blood flow velocity in the middle cerebral artery was higher in healthy subjects than in migraine patients ( P = 0.003-0.033) and unaffected by propranolol. We observed no effect of propranolol on GTN-induced headache and migraine. This could indicate that GTN induces migraine at a deeper level of the pathophysiological cascade of migraine than the prophylactic effect of propranolol. Propranolol does not constrict cerebral arteries, which therefore cannot be part of its mechanism of action in migraine.

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Migraine With Aura and Migraine Without Aura: An Epidemiological Study

Cephalalgia ◽

10.1046/j.1468-2982.1992.1204221.x ◽

1992 ◽

Vol 12 (4) ◽

pp. 221-228 ◽

Cited By ~ 348

Author(s):

Birthe Krogh Rasmussen ◽

Jes Olesen

Keyword(s):

Migraine With Aura ◽

Migraine Without Aura ◽

International Headache Society ◽

Age Distribution ◽

Cross Sectional Study ◽

Lifetime Prevalence ◽

Headache Disorders ◽

Cross Sectional ◽

Visual Disturbances ◽

Precipitating Factor

In a cross-sectional study of headache disorders in a representative general population of 1,000 persons the epidemiology of migraine with aura (MA) and migraine without aura (MO) was analysed in relation to sex and age distribution, symptomatology and precipitants. The headache disorders were classified on the basis of a clinical interview as well as a physical and a neurological examination using the operational diagnostic criteria of the International Headache Society (IHS). Lifetime prevalence of MA was 5%, male:female ratio 1:2. Lifetime prevalence of MO was 8%, M:F ratio 1:7. Women, but not men, were significantly more likely to have MO than MA. Neither MA nor MO showed correlation to age in the studied age interval (25–64 years). Premonitory symptoms occurred in 16% of subjects with MA and in 12% with MO. One or more precipitating factor was present in 61% with MA and in 90% with MO. In both MA and MO the most conspicuous precipitating factor was stress and mental tension. Visual disturbances were the most common aura phenomenon occurring in 90% of subjects with MA. Aura symptoms of sensory, motor or speech disturbances rarely occurred without coexisting visual disturbances. The pain phase of MA fulfilled the criteria for MO of the IHS. Headache was, however, less severe and shorter lasting in MA than in MO. Onset at menarche, menstrual precipitation, menstrual problems, influence of pregnancy and use of oral contraceptives all showed some relationship with the presence of MO and less with MA. The present findings suggest that MA and MO share the pain phase. Among subjects with MA and MO, 50% and 62%, respectively, had consulted their general practitioner because of migraine. Selection bias in previous clinical studies is demonstrated by comparisons with the present unselected sample.

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