A prospective study involving 72 children with recurrent headache, designed to determine whether the diagnosis of headache type made intuitively by each of 4 neurologists would have met the IHS diagnostic criteria, is reported from the Department of Pediatrics and Child Health, Children’s Hospital and University of Manitoba, Winnipeg, and the Division of Pediatric Neurology, Children’s Hospital, Calgary, Canada. The intuitive clinical diagnoses were as follows: migraine without aura (44 cases), migraine with aura (11), migraine and tension-type (11), tension-type (3), post-traumatic (2), and sinus (1). Features considered were location (unilateral or bilateral), quality (pulsating or pressing), intensity, exercise aggravation, nausea, vomiting, photophobia, phonophobia, and age. Dietary triggers were recognized in 8 of 44 children with migraine without aura, in 2 of 11 with migraine with aura, in 3 of 11 with combined migraine and tension headache, and in none with tension headaches. Family history of migraine in a first-degree relative occurred in 26 of 44 with migraine without aura, and 5 of 11 with migraine with aura. The intuitive diagnosis was completely concordant with the IHS criterion diagnosis in 61%, partially concordant in 31% and at complete variance in 8%. 
COMMENT. The authors concluded that the IHS criteria (1988), intended mainly for adults, can also be applied to children with recurrent headaches, but with some reservations. Revisions to the criteria should take into consideration the inability of children to describe the qualities and location of pain precisely. Children’s reports of the quality of headache pain are variable and may be exaggerated in the 9 to 11 age group and minimized in the 6 to 8 year olds (see Ped Neur Briefs April 1991). Prevalence of migraine diagnosis by IHS criteria also favored Caucasian over African-American children, 61% to 35%, in a more recent study. Minority children were less likely to present with vomiting, lateralized pain, or food as a precipitant of headache. (Ped Neur Briefs Nov 1993). The IHS criteria should be modified to increase their sensitivity to children and adolescents and also to racial differences in symptomatology. (Progress in Pediatric Neurology II, Chicago, PNB Publ, 1994).