Applicability of the 1988 IHS Criteria to Headache patients under the age of 18 years attending 21 Italian Headache Clinics

Abstract Seven hundred nineteen young patients attending 21 Italian headache care settings were evaluated by a diagnostic headache interview and a neurological examination. Headache disorders were classified according to the current 1988 criteria of the International Headache Society (IHS); 54.9% of the patients suffered from migraine, 33.9% from tension-type headache, 1.9% from secondary headache, and 3.4% had nonclassifiable headache. A further 5.9% of the patients were not classified due to incomplete questionnaires. Of the 395 patients with migraine, 44.5% were affected by migraine without aura, 29.9% by migraine with aura, 1.3% from other migraine forms, and 24.3% by migrainous disorders which do not fulfill the 1988 IHS diagnostic criteria for headache. Among the 244 patients with tension-type headache, 51.6% had episodic tension-type headache, 15.2% chronic tension-type headache, and 33.2% headache of the tension-type which does not fulfill the 1988 IHS criteria for episodic and chronic tension-type headache. In young migraine patients, pain was of a pulsating type in 55.7%, severe in 57.8%, unilateral in 42.6%, and aggravated by routine physical activity in 38.9%. Tension-type headache was described as pressing in 73.8%, mild or moderate in 75.7%, bilateral in 87.4%, and not aggravated by routine physical activity in 85.5%. The duration of pain was less than 2 hours in 35% of the cases in migraine sufferers and less than 30 minutes in 26.7% of tension-type headache sufferers. Nausea, phonophobia, and photophobia were present in at least half of the migraine patients and in one third of tension-type headache patients, respectively. Vomiting occurred in 47.8% of migraine patients and 9% of tension-type headache patients. On the basis of the above results, a modification of the current 1988 IHS criteria can be proposed to increase their sensitivity for diagnosing migraine and tension-type headache in children and adolescents. This should take into account that the attacks are of a shorter duration, the character of pain is not necessarily pulsating, and the location of pain may often be bilateral. The number of headache episodes should be reduced to less than five for the diagnosis of migraine and less th an 10 for the diagnosis of tension-type headache. Moreover, functional disability should not be considered a mandatory criterion for migraine in children and adolescents. Differentiating migraine and tension- type headache could be improved by the use of a grading system for accompanying symptoms (nausea, vomiting, phonophobia, and photophobia) rather than merely the use of criteria for absence and presence