IHS criteria and gender: a study on migraine and tension-type headache in children and adolescents.

Wober-Bingol C, Wober C, Wagner-Ennsgraber C, Zebenholzer K, Vesely C, Geldner J, Karwautz A.

Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria.

The aim of this study was to investigate whether the IHS criteria for migraine and tension-type headache depend on gender. Among 409 children and adolescents with recurrent idiopathic headache seen at a university outpatient clinic, girls had significantly more often migraine with aura. Also, there was a trend towards a higher frequency of tension-type headache in girls. In migraine, aggravation of headache by physical activity and occurrence of aura symptoms were more common in females, whereas vomiting and phonophobia occurred more often in males. In tension-type headache, females more often reported mild intensity of headache. All other criteria were similar in both sexes. Age influenced the expression of some of the accompanying symptoms in the various types of migraine, but had only minimal influence on other diagnostic criteria of migraine and tension-type headache in females as well as in males. Our study suggests that the frequency of migraine (except that of migraine with aura) is similar among girls and boys, that tension-type headache may occur more often in girls, and that gender has some influence on the IHS criteria for migraine, but almost no influence on those of tension-type headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8665576&dopt=Abstract headache medicine




Headache in patients with neurofibromatosis type 1.

Clementi M, Battistella PA, Rizzi L, Boni S, Tenconi R.

Dipartimento di Pediatria, Universita di Padova, Italy.

A study of headache in a homogeneously ascertained population of 181 subjects suffering from neurofibromatosis type 1 is described. All subjects underwent a diagnostic protocol including imaging studies (for subjects over 5 years old up until 1992). Headache data were collected by means of a questionnaire. Headache was present in 55 of 181 subjects (25 males). Overall headache frequency was 30%, which is not significantly different from the frequency of headache reported in the general population. Headache was primary in 52 cases (5 migraine and 47 tension-type) and secondary to obstructive hydrocephalus with brain tumor-induced intracranial hypertension in 3 with a tension-type pattern. It was concluded that headache is not a specific feature of neurofibromatosis type 1, it is not significantly related to central nervous system abnormalities, and in itself, it is not an indication for neuroradiological examination.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8666529&dopt=Abstract headache medicine




IHS criteria for migraine and tension-type headache in children and adolescents.

Wober-Bingol C, Wober C, Wagner-Ennsgraber C, Karwautz A, Vesely C, Zebenhoizer K, Geldner J.

Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria.

We investigated the influence of age on the IHS criteria for migraine and tension-type headache in 437 consecutive children and adolescents and found the following age-associated statistically significant differences: migraine duration, occurrence of migraine aura, and bilateral location of tension-type headache were more often fulfilled by adolescents, whereas aggravation of headache by physical activity (in migrainous disorder) and photophobia (in migraine with aura) were more often fulfilled by children. Accordingly, there are only a few differences concerning the fulfillment of the IHS criteria for migraine and tension-type headache in children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are most important for differentiating the two major types of idiopathic headache. The sensitivity of the IHS criteria for migraine could be increased by reducing the minimum duration of migraine and by allowing the diagnosis of migraine when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8675428&dopt=Abstract headache medicine




Diagnostic agreement in the classification of headache using Ad Hoc Committee and IHS criteria.

Wynkoop T, McCoy K, Dean RS.

Johns Hopkins University, School of Medicine.

This study examined the level of agreement between raters in the diagnosis of headache using the Ad Hoc Committee (AHC) on the Classification of Headache and the Headache Classification Committee of the International Headache Society (IHS) classification criteria. In addition, differences in classification of headache between the AHC and IHS classification systems were considered. Analyses indicated that both the AHC and IHS classification systems were adequate in allowing clinicians to reach 100% agreement in diagnosis of headache cases (N = 36). Additionally, there was 91.7% diagnostic agreement between the two sets of criteria as applied by the raters. Differences in diagnostic classification between the two sets of criteria were believed to be the result of IHS exclusionary criteria in the classification of Tension-type headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8734565&dopt=Abstract headache medicine




Magnetic resonance imaging for recurrent headache in childhood and adolescence.

Wober-Bingol C, Wober C, Prayer D, Wagner-Ennsgraber C, Karwautz A, Vesely C, Zebenholzer K, Feucht M.

Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria.

We investigated 429 consecutive patients, aged 5 to 18 (mean: 11.0 +/- 3.1) years, diagnosed with migraine or tension-type headache. The patients underwent either MRI or exclusively clinical follow-up examinations. Magnetic resonance imaging revealed normal findings in 82.3% and structural changes in 17.7%. However, the vast majority of these changes had minimal or no pathological relevance, and a causal relationship to the patient's headache could not be proven in any case. In the non-MRI group, clinical follow-up examinations confirmed the initial diagnosis in all patients and MRI was not required in any of these subjects. In conclusion, our study shows a poor relation between recurrent headache fulfilling the criteria of migraine and tension-type headache and structural changes incidentally detected by MRI. In addition, it suggests that clinical follow-up examinations are reliable. Accordingly, MRI is not required for routine examination of recurrent headache in children and adolescents, but it should be performed in patients with abnormal neurological findings, atypical headache pattern, or significant change of preexisting headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8742679&dopt=Abstract headache medicine




Pain perception and coping in female tension headache sufferers and headache-free controls.

Ukestad LK, Wittrock DA.

Department of Psychology, North Dakota State University, Fargo 58105, USA.

The purpose of this study was to investigate how headache sufferers and headache-free controls differ in their responses to acute pain. Thirty-three women completed the study (15 headache sufferers and 18 controls). The cold pressor was used to induce pain, and a partially inflated blood pressure cuff was used as a nonpainful comparison task. Headache sufferers reported more discomfort during both tasks; however, the 2 groups did not differ in the number of facial expressions of pain displayed during the tasks. Headache sufferers reported a tendency to catastrophize during both tasks; positive coping did not differ between the 2 groups. These results offer evidence that recurrent tension headache sufferers are more sensitive to both painful and nonpainful stimuli and that they cope differently from controls with these physical stressors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8788543&dopt=Abstract headache medicine




A nosographic analysis of the migraine aura in a general population.

Russell MB, Olesen J.

Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.

The study presented here is the first detailed nosographic analysis of migraine aura, diagnosed using the criteria of the International Headache Society, in a sufficiently large sample for statistical analysis. Of 4,000 people, 163 had migraine with aura. Sixty-two had attacks of migraine aura with headache as well as migraine aura without headache, and seven had exclusively migraine aura without headache. Visual symptoms were most frequent (99%), followed by sensory (31%), aphasic (18%) and motor (6%) symptoms. Those with several types of aura symptoms had visual aura in virtually every attack, while sensory, motor and aphasic aura were present only in a small number of their attacks. The typical visual aura starts as a flickering, uncoloured, zig-zag line in the centre of the visual field and affect the central vision. It gradually progresses towards the periphery of one hemifield and often leaves a scotoma. The typical sensory aura is unilateral, starts in the hand, progresses towards the arm and then affects the face and tongue. The typical motor aura is half-sided and affects the hand and arm. The visual, sensory and aphasic auras rarely lasted > 1 h, while the motor aura did in 67% (six out of nine). Four people had exclusively acute onset visual aura. The duration of the aura and the characteristics of the ensuing headache were typical for migraine with aura, suggesting that acute onset aura is a real phenomenon. Headache followed the aura in 93%, headache and aura occurred simultaneously in 4% and aura followed headache in 3%. The characteristic spread of each symptom and the sequence of different symptoms suggest that cortical spreading depression is the mechanism underlying the migraine aura. Our results do not suggest that alterations of the diagnostic criteria of the International Headache Society are needed. The intra-individual variation of aura symptoms shown in this study indicates that a simplification of the International Classification of Diseases, Neurological Adaptation is appropriate.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8800932&dopt=Abstract headache medicine




Cluster headache is an autosomal dominantly inherited disorder in some families: a complex segregation analysis.

Russell MB, Andersson PG, Thomsen LL, Iselius L.

Department of Neurology, University of Copenhagen, Denmark.

We investigated the mode of inheritance of cluster headache in 370 families. The probands were from a neurological clinic in Jutland and two departments of neurology in Copenhagen County, Denmark. The criteria of the International Headache Society were used. The patterns of segregation of cluster headache were assessed by complex segregation analysis performed with the computer program POINTER. Of the 370 probands with cluster headache, 25 had 36 relatives with cluster headache. The segregation analysis suggests that cluster headache has an autosomal dominant gene (p < 0.10) with a penetrance of 0.30-0.34 in males and 0.17-0.21 in females. The gene is present in 3 to 4% of males and 7 to 10% of females with cluster headache. An autosomal dominant gene has a role in cluster headache in some families.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8825923&dopt=Abstract headache medicine