High diagnostic stability of confirmed migraine and confirmed tension-type headache according to the ICHD-3 beta in adolescents

The Journal of Headache and Pain, Sep 2014

Background Stable headache diagnosis classification is a prerequisite for identification of headache type specific risk factors. Does the stability of a headache diagnosis over time vary between migraine and tension-type headache (TTH)? Are there differences in diagnosis stability between a probable and a definite headache diagnosis? Findings In a sample of 783 students (ages 12 to 18 years) participating in a headache intervention study in greater Munich, the stability of headache classification according to the International Classification of Headache Disorder - third edition (beta version) (ICHD-3 beta) after a follow-up of 7 months was examined. Differences in stability of probable or definite migraine and probable or definite TTH were assessed. The stability of the headache diagnosis was assessed as predictive value of headache diagnosis with regard to confirmation of the headache type using the same diagnostic instrument 7 months later. Predictive values with 95% confidence intervals (CI) are reported. Of students with initial migraine, a diagnosis of migraine was confirmed in 65.71% of students after 7 months (95%-CI [59.40-71.64]). A clear distinction between probable (44.71%, 95%-CI [33.91-53.89]) and confirmed diagnosis (76.88% 95%-CI [69.56-83.17]) of migraine was observed. For TTH the predictive value was 62.66% (95%-CI [57.07-68.01]) overall with a lower stability for probable (46.10%, 95%-CI [37.68-54.69]) compared to the confirmed diagnosis (69.71%, 95%-CI [23.58-37.67]). Conclusion While confirmed migraine and confirmed TTH diagnoses seem stable over time, stability of a probable diagnosis for either headache type was lower. Trial registration The trial was registered at the German Clinical Trial Register with the ID DRKS00003308.

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High diagnostic stability of confirmed migraine and confirmed tension-type headache according to the ICHD-3 beta in adolescents

The Journal of Headache and Pain High diagnostic stability of confirmed migraine and confirmed tension-type headache according to the ICHD-3 beta in adolescents Lucia Albers 0 Andreas Straube 2 Mirjam N Landgraf 1 Florian Heinen 1 Rüdiger von Kries 0 0 Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich , Haydnstr. 5, 80337 Munich , Germany 1 Department of Paediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich , Munich , Germany 2 Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany Background: Stable headache diagnosis classification is a prerequisite for identification of headache type specific risk factors. Does the stability of a headache diagnosis over time vary between migraine and tension-type headache (TTH)? Are there differences in diagnosis stability between a probable and a definite headache diagnosis? Findings: In a sample of 783 students (ages 12 to 18 years) participating in a headache intervention study in greater Munich, the stability of headache classification according to the International Classification of Headache Disorder - third edition (beta version) (ICHD-3 beta) after a follow-up of 7 months was examined. Differences in stability of probable or definite migraine and probable or definite TTH were assessed. The stability of the headache diagnosis was assessed as predictive value of headache diagnosis with regard to confirmation of the headache type using the same diagnostic instrument 7 months later. Predictive values with 95% confidence intervals (CI) are reported. Of students with initial migraine, a diagnosis of migraine was confirmed in 65.71% of students after 7 months (95%-CI [59.40-71.64]). A clear distinction between probable (44.71%, 95%-CI [33.91-53.89]) and confirmed diagnosis (76.88% 95%-CI [69.56-83.17]) of migraine was observed. For TTH the predictive value was 62.66% (95%-CI [57.07-68.01]) overall with a lower stability for probable (46.10%, 95%-CI [37.68-54.69]) compared to the confirmed diagnosis (69.71%, 95%-CI [23.58-37.67]). Conclusion: While confirmed migraine and confirmed TTH diagnoses seem stable over time, stability of a probable diagnosis for either headache type was lower. Trial registration: The trial was registered at the German Clinical Trial Register with the ID DRKS00003308. Headache; Migraine; Tension-type headache; Adolescents; Stability; Tracking; Headache type; Probable diagnosis; Confirmed diagnosis Introduction Headache is a common health complaint in children and adolescents. A recent review reporting on 64 cross-sectional studies from the last 25 years from 32 different countries and including a total of 227,249 children and adolescents estimated an overall mean prevalence of headache of 54.4% (95%-CI [43.1;65.8]) and an overall mean prevalence of migraine of 9.1% (95%-CI [7.1-11.1]) [ 1 ]. Correct classification of the headache type is a prerequisite for targeted treatment [ 2 ]. In face of the high prevalence of headache in children and adolescents, prevention of headache is a major public health challenge. Epidemiological studies are required for the identification of appropriate preventive interventions. In these studies classification of headache types often cannot be based on an assessment by a physician. While headache in general appears to be a stable trait over time [ 3 ], some fluctuation regarding the type of headache has been reported in clinical cohorts [ 4-6 ], where headache classification was based on physicians’ diagnoses, as well as in epidemiological cohorts, where classification was based on questionnaires according to the International Classification of Headache Disorder [ 7-10 ]. Potential causes for these fluctuations in reported headache types are: A) Presence of genuinely two different types of headache in a person with different prevailing symptoms over time, of which only the dominant symptoms determine diagnostic classification. B) Genuine Change of headache type over time. C) Poor reliability of the questionnaire or the physicians’ diagnosis. D) Poor validity of the questionnaire. In the setting of a cluster randomised trial, we had the opportunity to assess diagnostic stability of probable and confirmed TTH and migraine diagnoses over a seven-month period: How stable is the ICHD classification of Migraine and TTH? Does the stability vary differently between confirmed and probable migraine or TTH? Findings Population Our study population consists of 783 students recruited for the headache intervention study MUKIS (acronym for Münchner Untersuchung zu Kopfschmerzen bei Gymnasiasten – Interventionsstudie). MUKIS is a two-armed, prospective intervention study consisting of a baseline inquiry followed by an hour long in-class headache prevention lesson focusing on preventable risk factors for headache, as well as a follow-up inquiry approxim (...truncated)


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Lucia Albers, Andreas Straube, Mirjam N Landgraf, Florian Heinen, Rüdiger von Kries. High diagnostic stability of confirmed migraine and confirmed tension-type headache according to the ICHD-3 beta in adolescents, The Journal of Headache and Pain, 2014, pp. 36, Volume 15, Issue 1, DOI: 10.1186/1129-2377-15-36