The diagnostic rates based on various criteria and symptom complexes of children and adolescents with chronic headache were evaluated in 88 consecutive patients who attended the Pediatric Headache Clinic at the University of Maryland School of Medicine, Baltimore, 1989-1991. The male/female ratio was 1 (43:45). The mean age 12.5 years; 44 Caucasian and 40 African-American. Clinical migraine was diagnosed in 63 (74%), of which only 14% were classic in type. Migraine versus non-migraine diagnoses were not related to age, gender, or race. When International, Prensky, Vahlquist, and the author’s (Gladstein) criteria for migraine were used, the diagnosis was applied in only 50%. Prevalence of migraine diagnosis by the International criteria differed from the other classifications as a function of race, favoring Caucasians over African-American, 61% to 35%. Minority children were less likely to present with nausea, vomiting, lateralized pain, or food as a precipitant of headache. Children older than 12 years complained more often of radiating pain, scalp tenderness, and abdominal pain. Adolescent males reported higher rates of vomiting and decreased appetite than in females, while adolescent females found stress a more frequent precipitant. Older children and adolescents, especially females, used aspirin more frequently than those under 12 years of age. [1]

COMMENT. These findings suggest that the International Headache Society criteria (1988) should be modified to increase their sensitivity to children and adolescents, and criteria at present proposed for the pediatric headache population should be reexamined.

In 100 consecutive children with chronic, recurrent headaches as a presenting complaint seen in a private office during a 2 year period, 42 were diagnosed as migraine, of which 27 (64%) were classified as classic migraine. These were hemicranial, associated with visual phenomena and/or nausea and vomiting, and the family history was positive in the majority. The 15 patients with common migraine had generalized headaches complicated by visual phenomena, nausea, or vomiting. Phenytoin controlled the migraine in 77%; the beneficial response was unrelated to EEG abnormalities. In this study, a unilateral location and family history were considered important criteria in the diagnosis of classic migraine. The character of the pain, throbbing or pulsating, emphasized in some classifications, was considered unreliable in children and was not included in diagnosis. [2]

An uncommon EEG pattern, characterized by diffuse continuous beta activity, is described in an 8-year-old boy with recurrent migraine aura without headache from Ferrara University, Italy [3]. Epileptiform EEG discharges are not unusual in pediatric migraine patients.