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)