New Tool Aids in Diagnosis of Pediatric Migraine

Fran Lowry

January 17, 2013

A new structured interview has been shown to be a reliable and valid method for detecting migraine in children and teens in both clinical and community settings.

The Diagnostic Interview of Headache Syndromes–Child Version (DIHS-C) can be administered by nonclinicians to detect criteria for headache disorders, as set out in the second edition of the International Classification of Headache Disorders among children aged 7 to 18 years, write Tarannum Lateef, MD, MPH, from the National Institute of Mental Health, Bethesda, Maryland, and her colleagues.

Compared with an expert neurologist's diagnosis of migraine, the sensitivity with use of this tool was 98%. "In other words, we were able to accurately diagnose migraine in 98% of the children who had it with the interview," Dr. Lateef told Medscape Medical News.

Their findings were published online in Pediatrics.

Common and Debilitating

"Childhood headache is quite common and in many cases can even be debilitating," Dr. Lateef said. "We wanted to develop a tool that would allow for early and accurate diagnoses of headache syndromes in childhood. This is the best way to ensure appropriate treatment and improve outcomes for affected youth."

To this end, Dr. Lateef and her group conducted 104 pediatric headache interviews (53 in boys, 51 in girls) that were done as part of a community-based family study of migraine. In 40 of the children, a clinician had previously diagnosed migraine.

The researchers then compared the diagnosis of pediatric migraine made by the interview with the diagnosis made by the study neurologists.

They found that the DIHS-C was a reliable and valid means for ascertaining migraine in both clinical and community settings.

The overall sensitivity of the interview diagnosis compared with the expert neurologists' diagnosis of migraine was 98%, and specificity was 61%.

Dr. Lateef suggested that doctors can use this tool in their offices as an initial history-gathering method administered by a nonphysician. "The treating physician can then use the information. Often diagnoses may be overlooked since the physician does not have enough time to go over an extensive interview process for various diagnoses, and this interview can save time."

She added that she and her colleagues would like to see increased recognition of pediatric migraine in both community and clinical settings. "We hope that use of this diagnostic interview will lead to better management and better outcomes for migraine sufferers starting at an early age."

Migraine a Pediatric Problem

Commenting on this study for Medscape Medical News, Paul Graham Fisher, MD, the Beirne Family Professor of Pediatric Neuro-Oncology and professor, neurology and pediatrics, at Stanford University and Lucile Packard Children's Hospital, Palo Alto, California, noted, "Lateef and her team showed nicely that a structured interview, performed by nonphysician personnel, could detect very well those children and teens suffering from headache."

He noted limitations of the study, including that the small sample was "enriched" with migraine patients, and that the tool is long.

Despite these issues, "the work demonstrates further that migraine is indeed a pediatric problem and can be screened for by primary care personnel, not just pediatricians and specialists.

"While the researchers' tool might help best in the investigational arena, their approach, and perhaps that of successors, offers hope that more children who suffer from migraine can be identified in everyday clinics and remedied, so they can continue on with other aspects of their lives," Dr. Fisher concluded.

The study was supported by the National Institutes of Health. Dr. Lateef and Dr. Fisher have disclosed no relevant financial relationships.

Pediatrics. 2013;131:e96-e102. Published online December 24, 2012. Abstract