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

Background: The International Headache Society (IHS) diagnostic criteria (International classification of headache disorders edition 1 and 2- ICHD 1 and 2) for headache in children and adults improved the accuracy of migraine diagnoses. However many short duration headaches in children, receive an a typical migraine diagnosis -probable migraines according to ICHD 2 published in 2004 or migrainous disorders in ICHD1(1988). This study is to diagnose children and adolescents who presented with such atypical migraines of less than one hour duration. Methods: 1402 children and adolescents aged 5 to 15 years who presented with recurrent brief activity affected bead pain, were studied. Common migraine triggers and family history of migraine were recorded. Diagnosis was done according to ICHD2 and HIS(R) criteria. Objective: To diagnose early or brief migraine episodes in children and adolescents and to propose a modification to pediatric migraine diagnostic criteria of the International headache society. Design: Prospective study. Setting: Eye and Migraine Centre, Cherthala and St Sebastians Visitation Hospital, Arthunkal, Kerala. Results: All the children studied had moderate to severe headache lasting 5 to 45 minutes which forced them motionless during the attacks. At least one of the International Headache Society pediatric migraine diagnostic symptoms (nausea/vomiting/photophobia/phonophobia) was present in all. Two additional features were diagnostic of early or brief migraines in all of them- one of the parents or siblings was a migrainer and one of the common migraine triggers as a precipitating factor. Conclusion: This study concludes that if duration of head pain is less than one hour, two additional features to be included to diagnose definitive migraine in children and adolescents are: one migraine parent or sibling and one of the common migraine triggers precipitating the head pain. Keywords: Brief migraines, International headache society modification, Common migraine triggers, Family history