IHS Criteria for Migraine and Tension-Type Headache in Children and Adolescents

In this study, the causes, predisposing factors and clinical features of chronic daily headache in children and adolescents were studied within the population of patients attending a specialist headache. The International Headache Society's (IHS) criteria for the diagnosis of chronic tension type headache (CTTH) were assessed for their applicability in the paediatric age group. Over a period of three years, demographic and clinical data were collected prospectively on all children who attended the clinic and suffered from daily attacks of headache. One hundred and fifteen children and adolescents (32% of all clinic population) had chronic daily headache, of whom 93 patients (81%) fulfilled the IHS criteria for the diagnosis of CTTH. They were between 3-15 years of age (mean: 11.1, SD: 2.3) and their female to male ratio was 1.2: 1. Around one third of the patients also suffered from migraine (mainly migraine without aura). The headache was described as mild in 60.9%, moderate 36.5% and severe 2.6%. Headache was located at the forehead in 53% or over the whole of the head in 29.6%. Pain was described as ‘just sore’ or dull by 73.9%. During attacks of headache, at least half the patients reported light intolerance, noise intolerance, anorexia or nausea. Thirty-two percent of patients had at least one underlying chronic disease that may have contributed to the pathogenesis of the CTTH. Eleven percent had serious stressful events related to family illnesses and in four patients headaches were triggered by family bereavement. Fourteen percent were investigated with neuroimaging and 22% were referred for clinical psychology assessment and management. In conclusion, CTTH is a common cause of headache in children attending a specialist headache clinic. The clinical features closely match those of adult population and the IHS criteria for the diagnosis of CTTH can be adapted for use in children. Predisposing stressful risk factors, physical or emotional, are present in a large proportion.

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Diagnosis of Headache in Childhood and Adolescence: A Study in 437 Patients

Cephalalgia ◽

10.1046/j.1468-2982.1995.1501013.x ◽

1995 ◽

Vol 15 (1) ◽

pp. 13-21 ◽

Cited By ~ 86

Author(s):

C Wöber-Bingöl ◽

C Wöber ◽

A Karwautz ◽

C Vesely ◽

C Wagner-Ennsgraber ◽

...

Keyword(s):

Children And Adolescents ◽

Outpatient Clinic ◽

International Headache Society ◽

Tension Type Headache ◽

Childhood And Adolescence ◽

Highly Sensitive ◽

Ihs Criteria ◽

Type Headache ◽

Structured Questionnaire

We investigated whether the criteria for idiopathic headache published by the International Headache Society (IHS) are useful in childhood and adolescence and compared the diagnoses according to this classification with those of Vahlquist. We used a semi-structured questionnaire to examine a total of 437 children and adolescents referred consecutively to a headache outpatient clinic. Twenty-eight of 437 patients were excluded because of symptomatic or unclassifiable headache. Of 409 patients with idiopathic headache, 70.4% had definite migraine or tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder (IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria (IHS 2.3). In the differential diagnosis of migraine and tension-type headache the intensity of pain, aggravation of headache by physical activity, nausea and vomiting were the most important features. The quality of pain, photo- and phonophobia were less helpful and location least important. The duration of migraine attacks was less than 2 h in 19.0% of the migraine patients. In general, the diagnostic criteria of migraine were highly specific but less sensitive, and those of tension-type headache highly sensitive but less specific. The agreement between IHS criteria and those of Vahlquist was marked (kappa = 0.57). We conclude that the IHS criteria are useful for classifying headache in children and adolescents referred to a headache outpatient clinic. A forthcoming modification of the IHS criteria should consider a reduction of the minimum duration of migraine attacks from 2 h to I h and should try to increase the sensitivity of the criteria for migraine and the specificity of the criteria for tension-type headache.

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IHS Criteria and Gender: A Study on Migraine and Tension-Type Headache in Children and Adolescents

Cephalalgia ◽

10.1046/j.1468-2982.1996.1602107.x ◽

1996 ◽

Vol 16 (2) ◽

pp. 107-112 ◽

Cited By ~ 23

Author(s):

C Wöber-Bingöl ◽

C Wöber ◽

C Wagner-Ennsgraber ◽

K Zebenholzer ◽

C Vesely ◽

...

Keyword(s):

Physical Activity ◽

Children And Adolescents ◽

Diagnostic Criteria ◽

Migraine With Aura ◽

Outpatient Clinic ◽

Tension Type Headache ◽

Ihs Criteria ◽

Accompanying Symptoms ◽

And Gender ◽

Type Headache

The aim of this study was to investigate whether the IHS criteria for migraine and tension-type headache depend on gender. Among 409 children and adolescents with recurrent idiopathic headache seen at a university outpatient clinic, girls had significantly more often migraine with aura. Also, there was a trend towards a higher frequency of tension-type headache in girls. In migraine, aggravation of headache by physical activity and occurrence of aura symptoms were more common in females, whereas vomiting and phonophobia occurred more often in males. In tension-type headache, females more often reported mild intensity of headache. All other criteria were similar in both sexes. Age influenced the expression of some of the accompanying symptoms in the various types of migraine, but had only minimal influence on other diagnostic criteria of migraine and tension-type headache in females as well as in males. Our study suggests that the frequency of migraine (except that of migraine with aura) is similar among girls and boys, that tension-type headache may occur more often in girls, and that gender has some influence on the IHS criteria for migraine, but almost no influence on those of tension-type headache.

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Migrainous disorder and headache of the tension-type not fulfilling the criteria: a follow-up study in children and adolescents

Cephalalgia ◽

10.1111/j.1468-2982.2000.00090.x ◽

2000 ◽

Vol 20 (7) ◽

pp. 611-616 ◽

Cited By ~ 29

Author(s):

K Zebenholzer ◽

C Wöber ◽

C Kienbacher ◽

Ç Wöber-Bingöl

Keyword(s):

Children And Adolescents ◽

Diagnostic Criteria ◽

Migraine Without Aura ◽

Tension Type Headache ◽

Follow Up Study ◽

Ihs Criteria ◽

Type Headache

In this follow-up study in children and adolescents with recurrent headaches classified as migrainous disorder (IHS 1.7) and headache of the tension-type not fulfilling the criteria (IHS 2.3), 28.6% were headache-free and 71.4% still had headaches 2-5 years after the first examination. The majority remained in the same one-digit IHS diagnosis, whereas 20% changed from migraine to tension-type headache or vice versa. The number of IHS criteria fulfilled increased significantly from the first to the second examination. The reason for diagnosing IHS 1.7 and IHS 2.3 most often was a short headache duration or headache characteristics not meeting the criteria. By reducing the minimum headache duration to 1 h, 11 of 58 patients could be diagnosed as migraine without aura. There was a remarkable overlap in the diagnostic criteria for migraine without aura and tension-type headache. In IHS 1.7 and IHS 2.3 this overlap exceeded 80%, with a trend to decrease at the second examination.

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Global Burden of Headache Disorders in Children and Adolescents 2007–2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010250 ◽

2020 ◽

Vol 18 (1) ◽

pp. 250

Author(s):

Matilde Leonardi ◽

Licia Grazzi ◽

Domenico D’Amico ◽

Paolo Martelletti ◽

Erika Guastafierro ◽

...

Keyword(s):

Children And Adolescents ◽

Tension Type Headache ◽

Global Burden ◽

Specific Information ◽

Headache Disorders ◽

Substantial Impact ◽

Public Health Policies ◽

School Activities ◽

Type Headache ◽

Years Lived With Disability

Headache disorders are prevalent and disabling conditions impacting on people of all ages, including children and adolescents with substantial impact on their school activities and leisure time. Our study aims to report specific information on headaches in children and adolescents based on the Global Burden of Disease (GBD) study, that provides estimates for incidence, prevalence, fatal and non-fatal outcomes. We relied on 2007 and 2017 GBD estimates for prevalence and Years Lived with Disability (YLDs) at the global level and in WHO regions. The results show that, migraine and tension-type headache (TTH) together account for 37.5% of all-cause prevalence and for 7% of all-cause YLDs. Over the past decade, prevalence rates showed a mild increase of TTH in all ages and of migraine alone for adolescents. The YLDs increased among females of all ages with some regional differences that might be connected to the unequal availability of effective acute and prophylactic treatments across world regions. GBD data support the need to promote public health policies and strategies including diagnosis, pharmacological and non-pharmacological treatments that are expected to help reduce the disability and burden associated to migraine and TTH among children and adolescents.

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Tension-type headache in children and adolescents

Current Pain and Headache Reports ◽

10.1007/s11916-004-0073-1 ◽

2004 ◽

Vol 8 (6) ◽

pp. 500-504 ◽

Cited By ~ 7

Author(s):

Pirjo Anttila

Keyword(s):

Children And Adolescents ◽

Tension Type Headache ◽

Type Headache

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An epidemiological approach to the nosography of chronic daily headache

Cephalalgia ◽

10.1177/0333102493013s1216 ◽

1993 ◽

Vol 13 (12_suppl) ◽

pp. 72-77 ◽

Cited By ~ 39

Author(s):

Giorgio Sandrini ◽

Gian Camillo Manzoni ◽

Carla Zanferrari ◽

Giuseppe Nappi

Keyword(s):

Clinical Features ◽

Chronic Daily Headache ◽

Tension Type Headache ◽

Chronic Tension Type Headache ◽

Transformed Migraine ◽

Daily Headache ◽

Ihs Criteria ◽

Recent Classification ◽

Type Headache ◽

Epidemiological Approach

Chronic daily headache (CDH), a heterogeneous group of headaches, includes different forms that occur daily, or almost daily, over a prolonged period of time. The nosography of this group is still a matter of debate, and in the most recent classification of the IHS (1988) only a few types of CDH are included: chronic tension-type headache, coexisting migraine. This study is an epidemiological approach to identifying the clinical features of CDH and the possible factors involved in changing episodic headache in CDH. Ninety CDH outpatients were investigated using a computerized record chart. The main observed forms were: (a) chronic tension-type headache–migraine with interparoxysmal headache, an evolved form of migraine in which a constant low severity headache develops between attacks; (b) transformed migraine, an evolved form of migraine with progressive worsening of the disease which reaches the level of continuous pain with the disappearance of typical migraine attacks. Interval headaches in migraine with interparoxysmal headache partly fulfil the IHS criteria for chronic tension-type headache. Analgesic drug abuse plays a prominent role in inducing CDH and in determining its clinical features.

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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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