Using ICHD-3 beta vs ICHD-II to Diagnose Migraine With Typical Aura in Children

Use of the International Classification of Headache Disorders 3 (ICHD-3) beta classification criteria vs ICHD-II may result in an increased percentage of pediatric patients diagnosed with migraine with typical aura (MTA), according to a retrospective study published in Cephalalgia.¹

Investigators reviewed 164 charts of pediatric patients (mean age, 9.92±2.64 years) who had aura with an accompanying headache and who attended the Headache Centre of Bambino Gesù Pediatric Hospital in Rome, Italy, during a 9-year period. The researchers used either the ICHD-II or ICHD-3 criteria to diagnose headache in these patients.

In the ICHD-3 beta version, migraine with aura is defined as “recurrent attacks, lasting minutes, of unilateral fully reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated with migraine symptoms. Aura symptoms spreads gradually over 5 to 60 minutes…and are accompanied, or followed within 60 minutes, by headache.”²

Diagnosis for MTA were made on fully satisfying the ICHD criteria, whereas diagnosis for probable MTA was made after partial satisfaction of the ICHD.

A diagnosis of MTA was reached in 15.3% of patients using the ICHD-II criteria vs 77.7% of patients with ICHD-3 beta. A probable MTA diagnosis was established for 13.4% of patients with both ICHD-II and ICHD-3 beta (positive predictive value, 85%), and no determined diagnosis was reached for 9.5%, using either criteria. In a regression analysis, investigators found no connection between aura characteristics and pain characteristics, sex, or age (P >.05). Overall, the researchers demonstrated that the features of aura are independent of age and comparable with those observed in the adult patient population.

Because of the study’s retrospective design, the researchers suggest a prospective multicenter trial may provide findings that offer greater clinical applicability with the new criteria. They also point to possible errors in judgement regarding the true end of aura symptoms in some of the youngest children in this cohort.

Researchers conclude that headache features may not be necessary when establishing a diagnosis of MTA, representing a “benefit for the diagnosis of [migraine with aura] in pediatric patients, where the headache attack duration can be shorter than in adults.”

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References

1. Balestri M, Papetti L, Maiorani D, et al. Features of aura in paediatric migraine diagnosed using the ICHD 3 beta criteria [published online December 14, 2017]. Cephalalgia. doi: 10.1177/0333102417748571
2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808.