Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Headache. 2024 Nov-Dec;64(10):1217-1229. doi: 10.1111/head.14858. Epub 2024 Oct 27.
We used Cluster Analysis of Migraine-associated Symptoms (CAMS) to critically evaluate current International Classification of Headache Disorders-Third Edition (ICHD-3) migraine-associated symptoms criteria.
Diagnostic criteria play a central role in guiding clinical trial inclusion, and therefore available treatments. Migraine and tension-type headaches (TTH) are differentiated in ICHD-3 by many headache characteristics, including associated symptoms. A diagnosis of probable migraine indicates some but not all features of migraine are met. Photophobia and phonophobia, or nausea and/or vomiting, are required to meet a diagnosis of migraine; however, CAMS-a model that describes associated symptoms across youth with headache-indicates that a broader range of symptoms contain information about migraine burden.
In this multisite retrospective cross-sectional study, we evaluated ICHD-3 migraine criteria. Youth aged 6-17 years with migraine (including probable migraine) or TTH were included in the analysis. We used CAMS to evaluate the migraine-associated symptom criterion. With CAMS as a guide, we evaluated how changes to the migraine-associated symptom criterion altered who met the diagnosis of migraine.
Of the 9017 participants included in this study, 66.7% were female and had a median (interquartile range) age of 13 (10-15) years. Most participants had migraine or probable migraine (99.0%), and the remainder had TTH (1.0%). A sizable percentage (10.1%) of youth under the umbrella diagnosis of migraine were diagnosed with probable migraine because they did not meet migraine-associated symptom criterion D; however, many in this group reported several non-ICHD migraine-associated symptoms. We explored alterations to criterion D based on CAMS. Allowing for photophobia or phonophobia re-categorized 55.6% of youth as having migraine, though some only had one symptom. Including lightheadedness or lightheadedness and spinning re-categorized 19.7% and 25.8% of youth with migraine, respectively, but all of those who were re-categorized had at least two migraine-associated symptoms.
The ICHD-3 captures the most prevalent migraine-associated symptoms; however, many youths with probable migraine who do not meet full criteria due to insufficient associated symptoms nonetheless experience multiple non-ICHD migraine-associated symptoms. Changes to criterion D should be considered for the ICHD-4.
我们运用偏头痛伴随症状聚类分析（CAMS）对现行国际头痛疾病分类第三版（ICHD-3）偏头痛伴随症状标准进行严格评估。
诊断标准在指导临床试验纳入标准以及现有治疗方案方面发挥着核心作用。ICHD-3 依据多种头痛特征区分偏头痛和紧张型头痛（TTH），包括伴随症状。疑诊偏头痛患者只需满足部分而非全部偏头痛特征。畏光和畏声，或恶心和/或呕吐，是诊断偏头痛的必备条件；然而，CAMS（一种描述青少年头痛相关伴随症状的模型）表明，更广泛的症状谱包含了偏头痛负担的相关信息。
在这项多中心回顾性横断面研究中，我们评估了 ICHD-3 偏头痛标准。纳入分析的患者为年龄 6-17 岁、患有偏头痛（包括疑诊偏头痛）或 TTH 的青少年。我们运用 CAMS 评估偏头痛伴随症状标准。以 CAMS 为指导，我们评估了偏头痛伴随症状标准的改变如何影响偏头痛的诊断。
在这项研究中，共纳入 9017 名参与者，其中 66.7%为女性，年龄中位数（四分位距）为 13（10-15）岁。大多数参与者患有偏头痛或疑诊偏头痛（99.0%），其余参与者患有 TTH（1.0%）。在偏头痛这一总诊断伞下，有相当大比例（10.1%）的患者因未满足偏头痛伴随症状标准 D 而被诊断为疑诊偏头痛；然而，这部分患者中有许多人报告了几种非 ICHD 偏头痛伴随症状。我们根据 CAMS 探讨了标准 D 的改变。仅将畏光或畏声重新归类为偏头痛，即可使 55.6%的患者被诊断为偏头痛，尽管其中一些患者仅有一种症状。将头晕或头晕伴旋转分别重新归类为偏头痛，可使分别有 19.7%和 25.8%的偏头痛患者被重新归类，但所有被重新归类的患者至少有两种偏头痛伴随症状。
ICHD-3 囊括了最常见的偏头痛伴随症状；然而，许多因伴随症状不足而未满足全部标准的疑诊偏头痛患者仍经历多种非 ICHD 偏头痛伴随症状。ICHD-4 应考虑修改标准 D。
