The sensitivity of the new International Classification of Headache Disorders-2nd edition (ICHD-II) criteria in the diagnosis of childhood migraine was evaluated in 260 patients, ages 18 and under, seen at 2 large pediatric headache centers, and reported from Children’s Hospital Medical Center, Cincinnati, OH; The Cleveland Clinic, OH; and other centers. Each headache characteristic in ICHD-II was analyzed individually. ICHD-II criteria were met in 183 (70.4%) of 260 patients. When headache duration was included, the sensitivity was 71.9% for short duration (2 hours) and 73.9% for 1-hour duration headaches. When data were reanalyzed using more relaxed criteria, sensitivity improved to 84.4%. These modified criteria included bilateral headache, duration of 1 to 72 hours, and nausea and/or vomiting plus 2 of 5 other associated symptoms (photophobia, phonophobia, difficulty thinking, lightheadedness, or fatigue), in addition to moderate to severe, throbbing or pulsating pain worsening or limiting physical activity. [1]

COMMENT. Childhood migraine has unique characteristics, including bilateral location, shorter duration, and difficulty with description of headache quality and associated symptoms. Specificity of a migraine diagnosis is required to separate headaches of a secondary type. The separation of tension type headaches (TTH) is debatable, since some regard TTH and migraine as a continuum, from mild to severe. More inclusiveness in diagnosis could lead to a greater sensitivity than the 85% obtained using the ICHD-II criteria, and improvement in treatment and outcome.

In a comparison of ICHD-I-1988 and ICHD-II-2004 criteria in diagnosis of migraine in 496 children studied from 1992-2002, the current (ICHD-II) classification criteria showed greater sensitivity (71% cf 27%) without affecting specificity, but sensitivity was still poor. [2]