Classification of pediatric migraine: proposed revisions to the IHS criteria

Abstract

The International Headache Society classification lends itself to modification to significantly improve the diagnostic sensitivity of migraine in the pediatric population. Children and adolescents require special modifications relating to duration, location, quality of intensity, and symptoms related to photophobia and phonophobia. We propose specific criteria for pediatric migraine with and without aura which are more sensitive. Forty-five children and adolescents seen at a headache center were evaluated, retrospectively, comparing diagnostic criteria of the International Headache Society, Vahlquist, and the proposed revised IHS classification for clinical diagnosis by a single examiner (pediatric neurologist)--comparing diagnostic rates for migraine of the total sample: IHS (53%), Vahlquist (69%), and IHS-R (80%) and evaluating a subset of those patients less than 12 years (n = 22): IHS (50%), Vahlquist (68%), and IHS-R (73%). The proposed revisions to IHS for pediatric migraine were more sensitive than existing criteria. These revisions may help to form the basis for future research guidelines and for further modifications to improve the diagnostic sensitivity of pediatric migraine using the IHS model.