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On-line version ISSN 1678-4227
Arq. Neuro-Psiquiatr. vol.56 n.2 São Paulo June 1998
MIGRAINE IN CHILDHOOD AND ADOLESCENCE: A CRITICAL STUDY OF DIAGNOSTIC CRITERIA AND INFLUENCE OF AGE ON CLINICAL FINDINGS (ABSTRACT)*. THESIS. SÃO PAULO, 1998.
JOSÉ LUIZ DIAS GHERPELLI **
Two hundred and fifty-three children, aged < 15 years old, comprised the study group. The study was divided in 2 phases.
Phase 1 included 193 children with migraine with and without aura (1.1 and 1.2) diagnosed according to the IHS criteria, with a mean age of 10,3 y., divided in 2 groups according to their age (< 10 or > 10 years). We studied the relationship between age and migraine type, headache characteristics and associated symptoms that are part of the IHS definition. Results showed a statistically significant higher frequency of migraine with aura in children > 10 years old (p = 0.0002) compared to those with < 10 years; non-parametric statistical analysis showed a significant relation between older age and increase in migraine with aura frequency (p = 0.0003). Pulsatile quality and unilateral pain location were also related to age, being more frequent in older children (p = 0.02 and p = 0.01, respectively).
Phase 2 studied 176 children with headache (1.1, 1.7, 2.1, 2.2, 4), excluding those with migraine with aura. The objectives were to: 1. analyze which of the IHS definition items were responsible for the children's exclusion of the migraine (1.1) diagnosis; 2. study the concordance degree between the restrictive IHS criteria, Prensky and Vahlquist criteria, compared to an "extended" criteria used as a "gold standard", that included the non-classified children in the migraine group; 3. study the degree of sensitivity and specificity for each of the definition items of the IHS definition and; 4. analyze alternative definitions, based on the restrictive IHS definition, which could improve the sensitivity concerning the children of the 1.7 diagnostic group. The results showed that item B of the definition was the most frequent cause of exclusion in the 1.7 diagnostic group, compared to items C and D (all children fulfilled item A). Prensky criteria showed the highest sensitivity, compared to the Vahlquist and IHS, although all three criteria showed sensitivity over 70%. Headache characteristics and associated symptoms that showed sensitivity over 70%, in decreasing order of frequency, were: pain of moderate/severe intensity, pain duration between 2 to 48 hours, isolated photophobia, isolated phonophobia and aggravation with physical activity. Headache characteristics and associated symptoms that showed specificity over 70%, in decreasing order of frequency, were: nausea, vomiting, phonophobia and photophobia (all 3 with 100%), isolated photophobia, aggravation with physical activity and isolated phonophobia. Based on 3 alternative definitions, each of them modifying one item of the IHS definition (with the exception of item A), while maintaining the others unchanged, we compared the sensitivity and specificity of these alternative definitions with the "extended" criteria. We observed that the exclusion of item B led to a 10% increase of sensitivity compared to the restrictive IHS, without losing specificity.
We concluded that item B of the IHS criteria for migraine without aura in children and adolescents could be removed. This would include a number of patients, which are presently non-classified, without increasing the number of false-positives.
KEY WORDS: migraine, headache, migraine diagnosis, childhood, adolescence, specificity, sensitivity.
* Enxaqueca na infância e adolescência: estudo da influência da idade sobre os sintomas clínicos e estudo crítico dos critérios diagnósticos (Resumo). Tese de Livre-Docência: Disciplina de Neurologia Infantil, Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo.