scholarly journals Grey Zones in the Diagnosis of Adult Migraine without Aura Based on the International Classification of Headache Disorders-Iii Beta: Exploring the Covariates of Possible Migraine without Aura

2015 ◽  
Vol 20 (1) ◽  
pp. e1-e7 ◽  
Author(s):  
Aynur Ozge ◽  
Elif Aydinlar ◽  
Bahar Tasdelen
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Criteria ◽  
Motion Sickness ◽  
Migraine Without Aura ◽  
Clinical Characteristics ◽  
Diagnostic Value ◽  
Infantile Colic ◽  
Headache Disorders ◽  
Final Version

BACKGROUND: Exploring clinical characteristics and migraine covariates may be useful in the diagnosis of migraine without aura.OBJECTIVE: To evaluate the diagnostic value of the International Classification of Headache Disorders (ICHD)-III beta-based diagnosis of migraine without aura; to explore the covariates of possible migraine without aura using an analysis of grey zones in this area; and, finally, to make suggestions for the final version of the ICHD-III.METHODS: A total of 1365 patients (mean [± SD] age 38.5±10.4 years, 82.8% female) diagnosed with migraine without aura according to the criteria of the ICHD-III beta were included in the present tertiary care-based retrospective study. Patients meeting all of the criteria of the ICHD-III beta were classified as having full migraine without aura, while those who did not meet one, two or ≥3 of the diagnostic criteria were classified as zones I, II and III, respectively. The diagnostic value of the clinical characteristics and covariates of migraine were determined.RESULTS: Full migraine without aura was evident in 25.7% of the migraineurs. A higher likelihood of zone I classification was shown for an attack lasting 4 h to 72 h (OR 1.560; P=0.002), with pulsating quality (OR 4.096; P<0.001), concomitant nausea/vomiting (OR 2.300; P<0.001) and photophobia/phonophobia (OR 4.865; P<0.001). The first-rank determinants for full migraine without aura were sleep irregularities (OR 1.596; P=0.005) and periodic vomiting (OR 1.464; P=0.026). However, even if not mentioned in ICHD-III beta, the authors determined that motion sickness, abdominal pain or infantile colic attacks in childhood, associated dizziness and osmophobia have important diagnostic value.CONCLUSIONS: In cases that do not fulfill all of the diagnostic criteria although they are largely consistent with the characteristics of migraine in clinical terms, the authors believe that a history of infantile colic; periodic vomiting (but not periodic vomiting syndrome); recurrent abdominal pain; the presence of motion sickness or vertigo, dizziness or osmophobia accompanying the pain; and comorbid atopic disorder are characteristics that should to be discussed and considered as additional diagnostic criteria (covariates) in the preparation of the final version of ICHD-III.

A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

Cephalalgia ◽  
2019 ◽  
Vol 40 (4) ◽  
pp. 337-346 ◽  
Author(s):  
Alberto Terrin ◽  
Federico Mainardi ◽  
Carlo Lisotto ◽  
Edoardo Mampreso ◽  
Matteo Fuccaro ◽  
...  
Keyword(s):  
Prospective Study ◽  
Diagnostic Criteria ◽  
Migraine Without Aura ◽  
Tension Type Headache ◽  
Headache Disorders ◽  
Headache Attack ◽  
Accompanying Symptoms ◽  
Type Headache ◽  
A Prospective Study

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

scholarly journals Menstrual versus non-menstrual attacks of migraine without aura in women with and without menstrual migraine

Cephalalgia ◽  
2015 ◽  
Vol 35 (14) ◽  
pp. 1261-1268 ◽  
Author(s):  
Kjersti Grøtta Vetvik ◽  
Jūratė Šaltytė Benth ◽  
E Anne MacGregor ◽  
Christofer Lundqvist ◽  
Michael Bjørn Russell
Keyword(s):  
General Population ◽  
Migraine Without Aura ◽  
Clinical Characteristics ◽  
Repeated Measurements ◽  
Menstrual Migraine ◽  
Headache Disorders ◽  
Severe Nausea ◽  
Menstrual Cycles ◽  
Headache Diary

Objective The objective of this article is to compare clinical characteristics of menstrual and non-menstrual attacks of migraine without aura (MO), prospectively recorded in a headache diary, by women with and without a diagnosis of menstrual migraine without aura (MM) according to the International Classification of Headache Disorders (ICHD). Material and methods A total of 237 women from the general population with self-reported migraine in ≥50% of their menstrual periods were interviewed and classified by a physician according to the criteria of the ICHD II. Subsequently, all participants were instructed to complete a prospective headache diary for at least three menstrual cycles. Clinical characteristics of menstrual and non-menstrual attacks of MO were compared by a regression model for repeated measurements. Results In total, 123 (52%) women completed the diary. In the 56 women who were prospectively diagnosed with MM by diary, the menstrual MO-attacks were longer (on average 10.65 hours, 99% CI 3.17–18.12) and more frequently accompanied by severe nausea (OR 2.14, 99% CI 1.20–3.84) than non-menstrual MO-attacks. No significant differences between menstrual and non-menstrual MO-attacks were found among women with MO, but no MM. Conclusion In women from the general population, menstrual MO-attacks differ from non-menstrual attacks only in women who fulfil the ICHD criteria for MM.

scholarly journals Diagnostic value of combinations of symptoms of migraine and tension-type headache included in the diagnostic criteria for children and adolescents in the international classification of headache disorders 2nd edition

Folia Medica ◽  
2013 ◽  
Vol 55 (3-4) ◽  
pp. 46-55 ◽  
Author(s):  
Iliyana H. Pacheva ◽  
Ivan G. Milanov ◽  
Ivan S. Ivanov ◽  
Rumen S. Stefanov
Keyword(s):  
Physical Activity ◽  
Children And Adolescents ◽  
Diagnostic Criteria ◽  
Diagnostic Value ◽  
Tension Type Headache ◽  
Headache Disorders ◽  
Recurrent Headache ◽  
Severe Intensity ◽  
Type Headache

ABSTRACT AIM: To suggest diagnostic combinations of symptoms for migraine and tension type headache (TTH), and for differentiation of overlapping headache (classified as either migraine or TTH) through evaluation of the diagnostic value of combinations of characteristics included in the International Headache Society diagnostic criteria for migraine and TTH in children and adolescents. PATIENTS AND METHODS: The study comprised an epidemiological school-based study (412 of 1029 pupils with chronic / recurrent headache) and a clinical study conducted in the Pediatric Neurology Ward and outpatient clinic at Plovdiv Medical University Hospital (203 patients with chronic / recurrent headache). An inclusion criterion was at least two episodes of headache during the last year. Exclusion criteria were: headache occurring only during acute infections; withdrawal of informed consent. Headache was classified according to the International Classification of Headache Disorders 2nd edition (ICHD-II) The diagnostic value of all combinations of items in criteria C and D for migraine and TTH was measured by sensitivity, specificity, and odds ratio. RESULTS: The combination “unilateral location, severe intensity, aggravation by physical activity” had 100% specificity for migraine. The combination “bilateral location, pressingtightening quality, mild intensity, no aggravation by physical activity” had 100% specificity for TTH. The combinations: “migrainous location, severe intensity, aggravation by physical activity”, “severe intensity, nausea”, “pulsating quality, nausea”, “pulsating quality, migrainous location, aggravation by physical activity” seemed to pose the greatest risk for developing migraine. These combinations - “no nausea, no photophobia”, “bilateral location, mild intensity and either no aggravation by physical activity or pressing-tightening quality, or no nausea or no photophobia” increased the most the TTH risk. Using these combinations as additional criteria for overlapping headache we classi ed 50% of overlapping headache as TTH and 8.3% as migraine. CONCLUSIONS: Some combinations of symptoms clarify the diagnosis of migraine and TTH. More than 50% of overlapping headache could be differentiated as TTH or MWA by the proposed combinations.

scholarly journals Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia

Cephalalgia ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Mona Ameri Chalmer ◽  
Thomas Folkmann Hansen ◽  
Jes Olesen
Keyword(s):  
Diagnostic Criteria ◽  
Migraine Without Aura ◽  
Field Testing ◽  
Tension Type Headache ◽  
International Classification ◽  
Headache Disorders ◽  
Probable Migraine ◽  
Type Headache ◽  
Headache Patients

Introduction Osmophobia has been suggested as an additional symptom of migraine without aura, and a high prevalence of osmophobia of up to 50% has been reported in the literature. We conducted a nosographic study of osmophobia in all migraineurs and tension-type headache patients and a field testing of suggested diagnostic criteria of osmophobia, presented in the appendix of the second edition of The International Classification of Headache Disorders and suggested by Silva-Néto et al. and Wang et al ., in migraine without aura and tension-type headache patients (n = 1934). Materials and methods Each patient received a validated semi-structured interview. All subjects fulfilled the diagnostic criteria of the second edition of The International Classification of Headache Disorders for migraine or tension-type headache. Statistical analyses were performed using statistical software R. The statistical R package “Caret” was used to construct a confusion matrix and retrieve sensitivity, which is defined as the suggested criteria’s ability to correctly diagnose migraine without aura patients, and specificity, defined as the suggested criteria’s ability to not wrongly diagnose tension-type headache patients. Results Osmophobia was present in 33.5% of patients with migraine with aura, in 36.0% of patients with migraine without aura, and in 1.2% of patients with tension-type headache. All migraineurs with osmophobia also fulfilled the current criteria for migraine by having nausea or photophobia and phonophobia. The appendix criteria had a sensitivity of 0.96 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.65 and a specificity of 0.99 for probable migraine without aura. Both the criteria by Silva-Néto et al. and Wang et al. had a sensitivity of 0.98 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.66 and a specificity of 0.99 for probable migraine without aura. Discussion This study demonstrates the remarkable specificity of osmophobia. The criteria by Silva-Néto et al. and Wang et al. both had a higher sensitivity than the appendix criteria for migraine without aura; all three criteria had a low sensitivity for probable migraine without aura. However, neither the appendix criteria nor the criteria by Silva-Néto et al. or Wang et al. added any extra patients that would not have been diagnosed by the current diagnostic criteria for migraine. Osmophobia is a valuable symptom that may be useful to differentiate between migraine without aura and tension-type headache in difficult clinical cases. Conclusion Our results do not suggest that alterations of the current diagnostic criteria for migraine without aura are needed.

Clinical Characteristics and Therapeutic Results in a Series of 68 Patients with Occipital Neuralgia

Pain Medicine ◽  
2019 ◽  
Author(s):  
Enrique Martínez-Pías ◽  
Javier Trigo-López ◽  
David García-Azorín ◽  
Aisling McGreal ◽  
Ángel Luis Guerrero Peral
Keyword(s):  
Clinical Characteristics ◽  
Negative Impact ◽  
International Headache Society ◽  
Tertiary Hospital ◽  
Occipital Neuralgia ◽  
Headache Disorders ◽  
Number Of Patients ◽  
Therapeutic Results ◽  
Prolonged Latency

Abstract Objective Cranial pain is a condition that has a negative impact on human lives, and occipital neuralgia is among its causes. This study aims to evaluate the clinical characteristics and therapeutic results of a series of patients with occipital neuralgia. Design Prospective registry (observational study). Settings Headache outpatient clinic in a tertiary hospital. Subjects Sixty-eight cases. Methods Demographic and nosological characteristics have been analyzed, as well as treatment response of occipital neuralgia. All patients were recruited between January 2008 and January 2018, and the diagnosis of occipital neuralgia was made according to the International Headache Society (International Classification of Headache Disorders) criteria being utilized at the time of diagnosis. Results Sixty-eight patients were diagnosed with occipital neuralgia, which corresponded to 1.2% of the total number of patients (5,515) who visited our Headache Unit during the aforementioned period. Fifty-four (79.4%) of them were female. Baseline pain was present in 62 (91.1%) patients, and exacerbations in 42 (61.8%). Latency from onset (range) was 27.7 ± 56.1 (1–360) months. Conclusions Occipital neuralgia is an uncommon disorder in the sample explored. The prolonged latency between the onset of symptoms and diagnosis suggests that there should be an increased awareness of this disorder.

Chronobiology differs between men and women with cluster headache, clinical phenotype does not

Neurology ◽  
2017 ◽  
Vol 88 (11) ◽  
pp. 1069-1076 ◽  
Author(s):  
Nunu Lund ◽  
Mads Barloese ◽  
Anja Petersen ◽  
Bryan Haddock ◽  
Rigmor Jensen
Keyword(s):  
Cluster Headache ◽  
Clinical Characteristics ◽  
Clinical Phenotype ◽  
Correct Diagnosis ◽  
Diagnostic Delay ◽  
Headache Disorders ◽  
Structured Interviews ◽  
Secondary Sector ◽  
Headache Center

Objective:To describe differences between the sexes in the phenotype of cluster headache (CH) in a large, well-characterized clinical CH population.Methods:Patients from the Danish CH survey aged 18–65 years, diagnosed with CH according to International Classification of Headache Disorders, second edition, completed questionnaires and structured interviews.Results:A total of 351 patients with CH participated, with a male:female ratio of 2:1. The diurnal variation of attacks showed moments of peak prominence in men’s attack cycle to be advanced by 1 hour compared to women’s, despite no difference in self-reported bedtime or chronotype (p = 0.31). The onset of CH decreased with increasing age for both sexes. Diagnostic delay was numerically longer for men vs women (6.56 vs 5.50 years, p = 0.21); however, more women had previously been misdiagnosed (61.1% vs 45.5%, p < 0.01) and received the correct diagnosis at a tertiary headache center (38.8% vs 20.9%, p < 0.001). Only minor sex differences in clinical characteristics were found but chronic CH was more prevalent in women compared to men (44.0% vs 31.9%, p < 0.05).Conclusions:Despite a similar clinical phenotype, diurnal attack cycle is advanced by 1 hour in men with CH compared to women. Rhythmicity is a defining characteristic of CH and these findings suggest differences in the hypothalamus’ influence on attack occurrence between the sexes. In addition, women were more often misdiagnosed and diagnosis in the primary or secondary sector more often failed. Furthermore, women had chronic CH more frequently than men. A long diagnostic delay and frequent misdiagnosis emphasize the need for increased awareness of CH in both sexes.

scholarly journals International Classification of Headache Disorders - ICHD-4. Will medication-overuse headache survive?

2021 ◽  
pp. 72-74
Author(s):  
Mario Fernando Prieto Peres ◽  
Thaiza Agostini Córdoba de Lima ◽  
Marcelo Moraes Valença
Keyword(s):  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Critical Analysis ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
International Classification ◽  
Headache Disorders ◽  
Critical View

The article is a critical analysis of the diagnostic criteria for medication-overuse headache. This is an important discussion to improve the criteria in the next update, as well as providing a critical view for neurologists when applying the criteria to their clinical practice.

VESTIBULAR MIGRAINE-UPDATES AND CHALLENGES: REVIEW OF LITERATURE

2021 ◽  
pp. 1-5
Author(s):  
Aravind Varma Datla ◽  
Sibasankar Dalai
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Criteria ◽  
Clinical Characteristics ◽  
Vestibular Migraine ◽  
Review Of Literature ◽  
Headache Disorders ◽  
Classi Cation

Complaints of dizziness or vertigo entirely are common in patients with migraines, at least occasionally. Vestibular migraine was recently integrated as an independent article in the International Classication of Headache Disorders 3-beta appendix. Despite this, it is still an underdiagnosed condition. The exact mechanism of vestibular migraine is still unclear. This review presents an overview of the history, epidemiology, pathophysiology, clinical characteristics, diagnostic criteria, differential diagnosis and the treatment of VM.

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