Early or Brief Migraine in Children or Adolescents – A Modification to International Headache Society Pediatric Migraine Diagnostic Criteria

Abstract

Background: The International Headache Society (IHS) diagnostic criteria (ICHD-1 and ICHD-2) improved the accuracy of migraine diagnosis. However, many children with short-duration headaches receive a diagnosis of atypical or probable migraine because attacks lasting less than one hour do not satisfy existing criteria.

Methods: A prospective study of 1,402 children and adolescents aged 5–15 years presenting with recurrent, brief, activity-limiting headaches. Common migraine triggers and family history of migraine were recorded, and diagnoses were made according to ICHD-2 and IHS revised criteria.

Objective: To diagnose early or brief migraine episodes in children and adolescents and propose a modification to the International Headache Society pediatric migraine diagnostic criteria.

Design: Prospective study.

Setting: Eye and Migraine Centre, Cherthala, and St. Sebastian's Visitation Hospital, Arthunkal, Kerala.

Results: All children experienced moderate to severe headaches lasting 5–45 minutes, with at least one migraine-associated symptom (nausea, vomiting, photophobia, or phonophobia). Two additional features were consistently present: a parent or sibling with migraine and at least one common migraine trigger precipitating the attacks.

Conclusion: For headache episodes lasting less than one hour, two additional criteria should be incorporated into the pediatric migraine diagnostic criteria: (1) one migraine parent or sibling, and (2) one common migraine trigger precipitating the headache, enabling definitive diagnosis of brief migraine in children and adolescents.