Researchers have proposed an update to the International Classification of Headache Disorders-3 (ICHD-3) criteria for headache attributed to transient ischemic attacks (TIA). The new criteria have a higher sensitivity compared with existing criteria. The study was published in the Journal of Headache and Pain.

In this study 120 patients with TIA and 192 control individuals were interviewed using neurologist-conducted semistructured forms. Data on previous headaches, headaches around the time of a TIA, and characteristics of the TIA were collected.

Within 24 hours, 16 participants with TIA (13%) experienced a new type of headache compared with none of the control individuals. A preexisting type of headache with altered characteristics occurred in 9 participants with TIA (7.5%) compared with no control individuals, and a headache without altered characteristics occurred in 8 patients with TIA (6.6%) compared with 9 control individuals (4.6%).

Of the headaches experienced by participants with TIA, 24% fulfilled the ICHD-3 diagnostic criteria. None of the headaches experienced by control individuals met the criteria.

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To increase the sensitivity while preserving the specificity of the criteria, the researchers proposed updating the criteria to the following:

A. Headache fulfilling criterion C

B. TIA has been diagnosed

C. Evidence of causation demonstrated by 1 of the following:

         Any new headache occurring within 24 hours of TIA onset

         Any other headache occurring within 1 hour of TIA onset

D. Headache not better accounted for by another ICHD-3 diagnosis

The new criteria were found to be met for 94% of headaches experienced by patients with TIA. As the validity of these criteria was tested in only one group of patients with TIA, the researchers note that other studies and centers need to validate the results.

“[The results] illustrate how important it is to distinguish between a new type of headache, a usual type with and without altered characteristics,” noted the researchers.

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Reference

Lebedeva ER, Gurary NM, Olesen J. New diagnostic criteria for headache attributed to transient ischemic attacks. J Headache Pain. 2019;20:97.