Maytal J, Young M, Shechter A, Lipton R B
Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.
Neurology. 1997 Mar;48(3):602-7. doi: 10.1212/wnl.48.3.602.
The optimal criteria for the diagnosis of migraine without aura in children are controversial. One strategy for assessing the validity of diagnostic criteria is to compare them with expert clinical diagnoses.
To study the agreement between clinical headache diagnoses assigned by pediatric neurologists and symptom-based diagnoses using the International Headache Society (IHS) criteria as well as alternative case definitions.
We reviewed the records of 253 children and adolescents consecutively evaluated by pediatric neurologists at the Montefiore Headache Unit. Clinical diagnoses assigned by the physicians were used as the gold standard in evaluating the validity of the IHS criteria for the diagnosis of migraine without aura. Alternative symptom-based diagnoses were compared with the clinical gold standard.
Detailed headache histories were abstracted from charts of 253 children; 167 children had complete data on all features required for IHS diagnosis. Eighty-eight (52.7%) children received a diagnosis of migraine without aura. Using the clinical diagnosis as the gold standard, the IHS criteria had a sensitivity of 27.3% and a specificity of 92.4%. The poor sensitivity of the IHS definition is a consequence of the rarity of certain features in children clinically diagnosed with migraine: duration of 2 hours or longer (55.7%), unilateral pain (34.1%), vomiting (47.7%), and phonophobia (27.3%). Based on these findings we suggested a definition for pediatric migraine headache without aura that is less complex, more sensitive (71.6%), and almost as specific as the IHS criteria.
The IHS criteria for migraine without aura have poor sensitivity but high specificity using a clinical diagnosis as the gold standard. The IHS criteria should be modified to better reflect current pediatric clinical practice.
儿童无先兆偏头痛的最佳诊断标准存在争议。评估诊断标准有效性的一种策略是将其与专家临床诊断进行比较。
研究儿科神经科医生做出的临床头痛诊断与使用国际头痛协会（IHS）标准以及替代病例定义的基于症状的诊断之间的一致性。
我们回顾了蒙特菲奥里头痛科儿科神经科医生连续评估的253名儿童和青少年的记录。医生做出的临床诊断被用作评估IHS无先兆偏头痛诊断标准有效性的金标准。将基于症状的替代诊断与临床金标准进行比较。
从253名儿童的病历中提取了详细的头痛病史；167名儿童具备IHS诊断所需的所有特征的完整数据。88名（52.7%）儿童被诊断为无先兆偏头痛。以临床诊断作为金标准，IHS标准的敏感性为27.3%，特异性为92.4%。IHS定义敏感性差是因为临床诊断为偏头痛的儿童中某些特征罕见：持续时间2小时或更长（55.7%）、单侧疼痛（34.1%）、呕吐（47.7%）和畏声（27.3%）。基于这些发现，我们提出了一个更简单、更敏感（71.6%）且几乎与IHS标准一样特异的儿童无先兆偏头痛性头痛定义。
以临床诊断作为金标准，IHS无先兆偏头痛标准敏感性差但特异性高。IHS标准应进行修改，以更好地反映当前儿科临床实践。
