Migraine and Tension-Type Headache Among Children and Adolescents: Application of International Headache Society Criteria in a Clinical Setting

Introduction: The International Headache Society criteria were written in order to help physicians establish a headache diagnosis. However, sometimes children with headache do not seem to fit any diagnosis. The purpose of our study was to assess the application of the criteria in a clinical setting. Methods: Medical records of children referred for primary headache to the pediatric neurology clinic at Bnai Zion Medical Center from 2008 to 2017 were assessed. Results: A total of 989 patients (range 6-18 years; 53% female) were assessed at our neurology clinic. Twenty-four percent (n = 241) were diagnosed with tension-type headache, 26% (n = 256) with migraine, and 4.5% (45) with mixed headache. In 41.5% (410), we were unable to reach a specific diagnosis. No differences in gender or age were found between the groups. Children in the migraine group used more analgesic treatments to stop the headache attacks compared with the tension-type headache group (50% vs 38%, P = .001). Patients diagnosed with tension-type headache reported having more emotional difficulties ( P = .001). No significant differences were found in headache characteristics (ie, location, sidedness, character), frequency, or intensity between the younger children (ages 6-11) and the adolescents (ages 12-18) within either the tension-type headache or migraine groups. Conclusions: Retrospective application of International Headache Society criteria in a large cohort of children with headaches failed to diagnose a specific type of headache in 41.5% of children. Migraine and tension-type headache were equally prevalent, and both constituted a major burden on our patients’ everyday lives. We found no major differences in frequency, intensity, and characteristics of pain between younger children and adolescents.

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Use of MPV and MPV/Plt Ratio in the Differentiation of Migraine and Tension-Type Headache

Acta Haematologica Polonica ◽

10.2478/ahp-2018-0003 ◽

2018 ◽

Vol 49 (1) ◽

pp. 15-19

Author(s):

Ersin Kasim Ulusoy

Keyword(s):

Large Scale ◽

International Headache Society ◽

Primary Headache ◽

Tension Type Headache ◽

Healthy Control Group ◽

Control Group ◽

Neurology Clinic ◽

Healthy Control ◽

And Gender ◽

Type Headache

AbstractPurposeMean platelet volume (MPV) is an indicator of platelet (Plt) function and activation. The purpose of this study is to demonstrate whether MPV and MPV/Plt ratio, indicators of Plt activation, are increased in migraine patients, compared to tension-type headache (TTH) and healthy control groups, in our large-scale study, and whether these two primary headache types with unknown pathophysiology may be differentiated by using MPV and MPV/Plt ratio.Materials and methodsEighty patients diagnosed with migraine as per the 2004 diagnosis criteria of the International Headache Society (IHS), 80 patients with TTH who have applied to the Neurology Clinic of our hospital, and 80 healthy subjects who have applied to the Family Practice Clinic and Blood Bank were enrolled in this study. MPV and MPV/Plt ratio in both patients of similar age and gender who were diagnosed with migraine as well as in the TTH group and healthy control group were compared.FindingsThe MPV/Plt ratio was 0.046±0.008 in migraine patients, 0.037±0.009 in patients with TTH, and 0.036±0.009 in the healthy control group. This difference was statistically significant (p<0.05). The cutoff value of MPV/Plt ratio for differentiating migraine and TTH was 0.037. The sensitivity of this value was 92.5%, while specificity was 55%.Conclusion We have demonstrated that the most commonly confused primary headache types may be differentiated by using MPV and MPV/Plt ratio, and therefore, the disability caused by migraine and unsuitable, unnecessary, and long-term drug therapies may be avoided in patients.

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Prevalence and impact of headache in undergraduate students in Southern Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2010000600008 ◽

2010 ◽

Vol 68 (6) ◽

pp. 873-877 ◽

Cited By ~ 13

Author(s):

Asdrubal Falavigna ◽

Alisson Roberto Teles ◽

Maíra Cristina Velho ◽

Viviane Maria Vedana ◽

Roberta Castilhos da Silva ◽

...

Keyword(s):

Undergraduate Students ◽

International Headache Society ◽

Primary Headache ◽

Tension Type Headache ◽

Significant Difference ◽

Headache Episode ◽

Headache Type ◽

Probable Migraine ◽

Type Headache ◽

The University

OBJECTIVE: To determine the prevalence, characteristics and impact of headache among university students. METHOD: The criteria established by the International Headache Society were used to define the primary headache subtypes and the Migraine Disability Assessment Questionnaire (MIDAS), to assess the disability. The students were then grouped into six categories: [1] migraine; [2] probable migraine; [3] tension-type headache; [4] probable tension-type headache; [5] non-classifiable headache; [6] no headache. RESULTS: Of all undergraduate students interviewed, 74.5% had at least one headache episode in the last three months. Regarding disability, there was a significant difference between the headache types (p<0.0001). In the post-hoc analysis, migraine was the headache type with most reported disability. CONCLUSION: Headache is a highly prevalent condition among the students at the University of Caxias do Sul. This disease may have a major impact on the students' lives and in some cases, ultimately lead to educational failure.

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Headache Prevalence Among Adolescents — The German DMKG Headache Study

Cephalalgia ◽

10.1111/j.1468-2982.2007.01289.x ◽

2007 ◽

Vol 27 (4) ◽

pp. 347-354 ◽

Cited By ~ 101

Author(s):

K Fendrich ◽

M Vennemann ◽

V Pfaffenrath ◽

S Evers ◽

A May ◽

...

Keyword(s):

International Headache Society ◽

Primary Headache ◽

Population Based ◽

Cross Sectional Study ◽

Tension Type Headache ◽

Cross Sectional ◽

Primary Headache Disorders ◽

Ihs Criteria ◽

Probable Migraine ◽

Type Headache

This population-based cross-sectional study examined the 3-month prevalence of headache, migraine and tension-type headache (TTH) among adolescents aged 12-15 years in Germany Students ( n = 3324) from 20 schools completed a questionnaire on general and headache-specific pain which included a sociodemographic module. The headache-specific questionnaire complied with the respective revised criteria of the International Headache Society (IHS). 'Modified criteria' changed the item 'duration' in migraine (>30 min instead of >4 h). The overall 3-month prevalence of headache was 69.4% (boys 59.5%, girls 78.9%), with 4.4% of the adolescents suffering from frequent (≥ 14 days/3 months) and severe (grade 8-10 on a 10-point visual analogue scale) headache and 1.4% (boys 0.9%, girls 1.9%) from headache ≥15 days/month. The 3-month prevalence of migraine was 2.6% (boys 1.6%, girls 3.5%) applying strict IHS criteria and 6.9% (boys 4.4%, girls 9.3%) with modified criteria; 12.6% (boys 8.3%, girls 16.7%) suffered from probable migraine, 0.07% fulfilled the criteria for chronic migraine, 4.5% (boys 4.6%, girls 4.3%) suffered from TTH, 0.2% from chronic TTH and 15.7% (boys 14.5%, girls 16.9%) from probable TTH. Headache and migraine were more common in girls than in boys and in teenagers, especially in girls, aiming at higher education. Recurrent headache and primary headache disorders are common complaints among German adolescents, especially among girls.

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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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Mixed Migraine and Tension-type: A Common Cause of Recurrent Headache in Children

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100003371 ◽

2004 ◽

Vol 31 (3) ◽

pp. 315-318 ◽

Cited By ~ 4

Author(s):

Shashi S. Seshia

Keyword(s):

Children And Adolescents ◽

Private Practice ◽

Tension Type Headache ◽

Recurrent Headache ◽

Or Practice ◽

Neurology Clinic ◽

Headache Type ◽

Canadian City ◽

Pediatric Neurologist ◽

Type Headache

Objective:Determine relative frequency of recurrent headache (HA) types in children and adolescents referred to a pediatric neurologist. Methods and subjects: Study design: Prospective, sequential, and observational. Setting: Private practice Pediatric Neurology Clinic in a Canadian city (Winnipeg). Patients and data collection: Information on those referred with HA between September 1998 and December 2001 was entered on data sheets. Patients were followed up for one month to four years.Results:Three hundred and twenty (69%) of 463 referred with HAhad recurrent HA. There were 172 males (54%) and 148 (46%) females. Their ages ranged from two years to 19 years (median: 11 years). They had had their HA disorder for one month to 14 years (median: two years) prior to assessment. Migraine was the main HA type in 124 (38%), tension-type headache (TTH) in 57 (18%) and mixed migraine and TTH in 101 (32%). Thus, 101 (45%) of 225 with migraine as one HAtype also had TTH.Conclusion:Tension-type headache and migraine frequently co-exist and may represent a distinct headache type, at least in children; the association will likely influence response of affected children and adolescents to specific migraine treatments in clinical trials or practice.

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Diagnosis of primary headache in children younger than 6 years: A clinical challenge

Cephalalgia ◽

10.1177/0333102416660533 ◽

2016 ◽

Vol 37 (10) ◽

pp. 947-954 ◽

Cited By ~ 13

Author(s):

Roberto Torriero ◽

Alessandro Capuano ◽

Rosanna Mariani ◽

Roberto Frusciante ◽

Samuela Tarantino ◽

...

Keyword(s):

International Headache Society ◽

Primary Headache ◽

Tension Type Headache ◽

Preschool Age ◽

Clinical Feature ◽

Primary Headaches ◽

Clinical Challenge ◽

Adults And Children ◽

Type Headache

Background Criteria defined by the International headache Society are commonly used for the diagnosis of the different headache types in both adults and children. However, some authors have stressed some limits of these criteria when applied to preschool age. Objective Our study aimed to describe the characteristics of primary headaches in children younger than 6 years and investigate how often the International Classification of Headache Disorders (ICHD) criteria allow a definitive diagnosis. Methods This retrospective study analysed the clinical feature of 368 children younger than 6 years with primary headache. Results We found that in our patients the percentage of undefined diagnosis was high when either the ICHD-II or the ICHD-III criteria were used. More than 70% of our children showed a duration of their attacks shorter than 1 hour. The absence of photophobia/phonophobia and nausea/vomiting significantly correlate with tension-type headache (TTH) and probable TTH. The number of first-degree relatives with migraine was positively correlated to the diagnosis of migraine in the patients ( p < 0.001). Conclusions Our study showed that the ICHD-III criteria are difficult to use in children younger than 6 years. The problem is not solved by the reduction of the lowest duration limit for the diagnosis of migraine to 1 hour, as was done in the ICHD-II.

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Prevalence and disability of headache among Norwegian adolescents: A cross-sectional school-based study

Cephalalgia ◽

10.1177/0333102415573512 ◽

2015 ◽

Vol 35 (13) ◽

pp. 1181-1191 ◽

Cited By ~ 32

Author(s):

Anne-Berit Krogh ◽

Bo Larsson ◽

Mattias Linde

Keyword(s):

International Headache Society ◽

Tension Type Headache ◽

Cluster Sampling ◽

Cross Sectional ◽

Similar Frequency ◽

Pediatric Migraine ◽

School Based ◽

Epidemiological Surveys ◽

Headache Diagnosis ◽

Type Headache

Background Headache is common in adolescents and affects schoolwork and relations with friends and family. In most previous epidemiological surveys, only the most bothersome headache has been documented. The aim was to determine headache prevalence not only taking into account the most bothersome headache, but also to compare characteristics of the most bothersome and less bothersome headaches, and to investigate headache-related disability. Methods A cross-sectional school-based study was conducted in which 493 representative adolescents aged 12–18 years were recruited by stratified cluster sampling and interviewed. Headache diagnosis was made according to the new classification system of the International Headache Society (ICHD-3 beta), and the Pediatric Migraine Disability Assessment (PedMIDAS) was used to evaluate disability. Results The one-year prevalence of any headache type, definite migraine, probable migraine and tension-type headache was 88%, 23%, 13% and 58%, respectively. The point prevalence of any headache was 38%. Nine percent of participants fulfilled criteria for more than one headache diagnosis. The most bothersome headache had a significantly longer duration ( p < 0.001) and higher intensity ( p < 0.001) than the less bothersome headache, but similar frequency ( p = 0.86). Adolescents with headaches lost up to nine days of activity each year, implicating headache as a major health issue. Conclusions Headaches are very common and disabling among adolescents. The full extent of this health problem is better appreciated if inquiry is not limited to the most bothersome subtypes.

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Diagnosis and Clinical Management of Headaches

CNS Spectrums ◽

10.1017/s1092852900012153 ◽

1999 ◽

Vol 4 (9) ◽

pp. 32-37

Author(s):

Daniel P. Greenfield ◽

Subramanian Hariharan

Keyword(s):

Clinical Management ◽

International Headache Society ◽

Brain Lesion ◽

Pain Syndrome ◽

Primary Headache ◽

Tension Type Headache ◽

Primary Headaches ◽

Primary Headache Disorders ◽

Primary Disorder ◽

Type Headache

AbstractIn this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.

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Headache Classification by History has Only Limited Predictive Value for Headache Episodes Treated in Controlled Trials With OTC Analgesics

Cephalalgia ◽

10.1111/j.1468-2982.2008.01706.x ◽

2009 ◽

Vol 29 (2) ◽

pp. 188-193 ◽

Cited By ~ 8

Author(s):

H-C Diener ◽

V Pfaffenrath ◽

L Pageler ◽

H Peil ◽

B Aicher ◽

...

Keyword(s):

International Headache Society ◽

Tension Type Headache ◽

Initial Diagnosis ◽

Prior History ◽

Double Blind Study ◽

Double Blind ◽

Efficacy Analysis ◽

Headache Type ◽

Headache Diagnosis ◽

Type Headache

We investigated the consistency between the headache diagnosis based on medical history and three treated headache episodes diagnosed based on a diary. In a randomized double-blind study including individuals with either migraine or tension-type headache (TTH) we showed significant superiority of the fixed combination of acetylsalicylic acid + paracetamol + caffeine over the combination without caffeine, the single preparations, and placebo in the treatment of headache. A neurologist performed a classification of the usual headache episodes and each of the three treated ones in a blinded fashion based on a structured questionnaire. This was done for the 1734 patients included in the efficacy analysis who usually treated their episodic TTH or migraine attacks with non-prescription analgesics. The overall percentage of patients with migraine and TTH remained relatively stable. The treated headache episodes were between 75 and 77% migraine, 18–20% were TTH and 5–7% could not be classified. We observed some shift in headache type within patients from prior history and in treated attacks. In 60% of patients all three treated episodes were of the type initially diagnosed by the neurologist by history (56% migraine and 4% episodic TTH). Of those with an initial diagnosis of migraine, 24% had at least one attack meeting criteria for TTH. Of patients with an initial diagnosis of TTH, 54% had at least one attack meeting the diagnostic criteria for migraine. Our results demonstrate that an initial headache diagnosis does not accurately predict the headache type treated in a randomized trial. Symptom features of treated headaches should be captured to ensure that the attack is of the type targeted by the clinical trial. The International Headache Society Guidelines for controlled clinical trials should be updated accordingly.

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A headache clinic-based approach to field trials of the International Headache Society criteria

Cephalalgia ◽

10.1177/0333102493013s1213 ◽

1993 ◽

Vol 13 (12_suppl) ◽

pp. 63-65 ◽

Cited By ~ 7

Author(s):

Seymour Solomon ◽

Richard B Lipton

Keyword(s):

Primary Care Physicians ◽

International Headache Society ◽

Field Trials ◽

Tension Type Headache ◽

Subjective Data ◽

Headache Diagnosis ◽

Daily Headache ◽

Headache Clinic ◽

Type Headache ◽

Operational Criteria

Criteria for the diagnosis of headache disorders have recently been developed but require empirical validation. We present an approach to the evaluation of headache criteria in a headache clinic: define the group of headache sufferers to be studied, obtain data used in establishing the diagnosis, apply the diagnostic criteria and assess their usefulness. In applying this method to a group of patients with chronic daily headache, we found that approximately one-third would not fit the current criteria for chronic tension-type headache. We conclude that empiric validation of headache criteria based on subjective data is a complex and iterative process. Operational criteria for headache diagnosis to be used by primary care physicians should be validated in that setting and ideally should be relatively simple.

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