Migraine and Tension-Type Headache among Children and Adolescents– Application of International Headache Society Criteria a Clinical Setting

Introduction: The International Headache Criteria were written in order to help physicians to establishing headache diagnosis. However, sometimes children with headache do not fulfill any diagnosis. The purpose of our study was to assess the clinical application of the criteria in a clinical setting.

Methods: Medical records of children referred for primary headache to the pediatric neurology clinic at Bnai Zion Medical Center from 2008 to 2017 were assessed.

Results: 989 patients (range 6–18 years; 53% females) were assessed at our neurology clinic. 24% (N=241) were diagnosed with TTH, 26% (N=256) with migraine, 4.5% (45) had mixed headaches and in 41.5% (410) we were unable to reach a specific diagnosis. Children in the migraine group used more analgesic treatments to stop the headache attacks compared to the TTH group (50% vs. 38%, p=0.001). Patients diagnosed with TTH reported having more emotional difficulties (p = 0.001). No significant differences were found in headache characteristics (i.e. location, sidedness, character), frequency or intensity between the younger children (ages 6–11) and the adolescents (ages 12–18) within either group, TTH or migraine.

Conclusions: Retrospective application of International Headache Society Criteria in a large cohort of children with headaches failed to diagnose a specific type of headache in 41.5% of children. Migraine and TTH were equally prevalent, and both constituted a major burden on our patients` everyday lives. We found no major differences in frequency, intensity, and characteristics of pain between younger children and adolescents.