Wöber-Bingöl C, Wöber C, Karwautz A, Vesely C, Wagner-Ennsgraber C, Amminger G P, Zebenholzer K, Geldner J, Baischer W, Schuch B
Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria.
Cephalalgia. 1995 Feb;15(1):13-21; discussion 4. doi: 10.1046/j.1468-2982.1995.1501013.x.
We investigated whether the criteria for idiopathic headache published by the International Headache Society (IHS) are useful in childhood and adolescence and compared the diagnoses according to this classification with those of Vahlquist. We used a semi-structured questionnaire to examine a total of 437 children and adolescents referred consecutively to a headache outpatient clinic. Twenty-eight of 437 patients were excluded because of symptomatic or unclassifiable headache. Of 409 patients with idiopathic headache, 70.4% had definite migraine or tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder (IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria (IHS 2.3). In the differential diagnosis of migraine and tension-type headache the intensity of pain, aggravation of headache by physical activity, nausea and vomiting were the most important features. The quality of pain, photo- and phonophobia were less helpful and location least important. The duration of migraine attacks was less than 2 h in 19.0% of the migraine patients. In general, the diagnostic criteria of migraine were highly specific but less sensitive, and those of tension-type headache highly sensitive but less specific. The agreement between IHS criteria and those of Vahlquist was marked (kappa = 0.57). We conclude that the IHS criteria are useful for classifying headache in children and adolescents referred to a headache outpatient clinic. A forthcoming modification of the IHS criteria should consider a reduction of the minimum duration of migraine attacks from 2 h to 1 h and should try to increase the sensitivity of the criteria for migraine and the specificity of the criteria for tension-type headache.
我们调查了国际头痛协会（IHS）发布的特发性头痛标准在儿童和青少年中是否有用，并将根据该分类的诊断结果与瓦尔奎斯特（Vahlquist）的诊断结果进行了比较。我们使用半结构化问卷对总共437名连续转诊至头痛门诊的儿童和青少年进行了检查。437例患者中有28例因症状性头痛或无法分类的头痛而被排除。在409例特发性头痛患者中，70.4%患有明确的偏头痛或紧张型头痛（IHS 1.1、1.2、2.1、2.2），20.5%患有偏头痛性疾病（IHS 1.7），9.1%患有不符合标准的紧张型头痛（IHS 2.3）。在偏头痛和紧张型头痛的鉴别诊断中，疼痛强度、体力活动使头痛加重、恶心和呕吐是最重要的特征。疼痛性质、畏光和畏声的帮助较小，疼痛部位最不重要。19.0%的偏头痛患者偏头痛发作持续时间少于2小时。总体而言，偏头痛的诊断标准特异性高但敏感性低，紧张型头痛的诊断标准敏感性高但特异性低。IHS标准与瓦尔奎斯特标准之间的一致性显著（kappa = 0.57）。我们得出结论，IHS标准有助于对转诊至头痛门诊的儿童和青少年的头痛进行分类。IHS标准即将进行的修订应考虑将偏头痛发作的最短持续时间从2小时缩短至1小时，并应努力提高偏头痛标准的敏感性和紧张型头痛标准的特异性。
