Diagnosis of Migraine in the Pediatric Emergency Department
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Pediatric emergency medicine
Tension headache
Migraine Disorders
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To estimate the lifetime migraine prevalence in school adolescents aged 13–15 in Taiwan, we conducted a self‐administered questionnaire survey in four sampled public junior high schools. Migraine was diagnosed according to the diagnostic criteria of the International Headache Society. A total of 4064 students (1983 boys, 2081 girls) completed the questionnaire (response rate 91.6%). The lifetime prevalence of migraine was 6.8%. It was significantly higher in girls than boys (7.8% vs. 5.7%) and increased with age in both sexes. Students with migraine were more likely to be absent from school because of their headaches than those with non‐migraine headaches (30% vs. 14%, odds ratio (OR) 2.7). They were also more likely to use painkillers for their headaches than their non‐migraine headache peers (72% vs. 40%, OR 4.0). These results suggest that migraine is a common disorder of adolescents in Taiwan and its impact on the quality of life can not be ignored.
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Neurology. 2002;58(9 suppl 6):S21‐S26. Although people with migraine are aware of their headaches they are often not aware that they have migraine. This can lead to inappropriate or ineffective use of treatments, delays in seeking appropriate care, and miscommunication during clinical encounters. This article assesses self‐recognition of migraine and identifies terms used by migraine sufferers to describe their migraine headaches. Individuals were selected for telephone interview by random digit dialing in several large United States cities as a part of a clinical trials recruiting initiative. Individuals (n = 30 758) aged 18 to 65 years of age were interviewed about their headaches using a validated computer‐assisted telephone interview. Among the 23 564 respondents who reported headache, their headaches were classified as migraine (with or without aura) by the criteria of the International Headache Society (IHS). The relationships among the terms subjects used for their headaches and their IHS diagnosis of migraine were assessed. Of the 23 564 respondents, 4967 individuals called their headache migraine and 3074 individuals reported headache that met the IHS criteria for migraine. The positive predictive value for self‐assessed migraine is 33.1%; the negative predictive value for a self‐assessment other than migraine is 92.3%. Therefore, individuals who called their headaches migraine were about three times more likely to meet IHS criteria for migraine. Among the 3074 individuals meeting IHS criteria for migraine, only 53.4% recognized their headaches as migraine (sensitivity 54%; specificity 83.8%). Among migraineurs, stress headaches (n = 345) and sinus headaches (n = 365) were the most common erroneous labels reported. Age influenced the erroneous terminology. Individuals less than 40 years of age were more likely to misidentify their migraine as stress headaches, whereas individuals 40 years of age and older were more likely to misidentify their migraines as sinus headaches. In a population sample, 54% of individuals with IHS migraine did not know that their headaches are migraine. Those who called their headaches migraine were much more likely to have migraine. Migraine awareness programs that rely solely on the term “migraine” may miss individuals who urgently need to be reached. Therefore, public education should target people with severe or disabling headache and aim to create awareness of the diagnostic possibilities. Comment: In the general population, and in contrast to the doctor's office, episodic tension‐type headache is more common than migraine. When a person in the general population self‐diagnoses nonmigraine, the diagnosis is likely to be correct. These tension or “stress” headaches do not frequently rise to a level that compels those afflicted to seek medical attention. SJT
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Introduction: Optometrists frequently encounter patients with migraine headache that patients suspect visual anomalies trigger headaches. According to controversial results between migraine headaches and refractive errors, the purpose of this study was investigation of relationship between refractive errors and migraine.
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Two thirds of all children are seen at some time during childhood for severe headache. Most headaches in children and adolescents are tension or migraine headaches (2% to 5% is a conservative migraine prevalence rate in children). Correct diagnosis is based on clinical history, and children and adolescents may have difficulty describing their …
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• We investigated stripe-induced visual discomfort and its relation to migraine. Some people find viewing striped patterns aversive. Prior work has suggested that migraineurs, in particular, are bothered by stripes. Subjects were selected by opportunity sampling. They were shown striped patterns and asked questions about their general health and their headache history, if any. Of the 102 subjects, 38 were diagnosed as having migraine headaches, 22 had nonmigraine headaches, and 42 were considered to be nonheadache subjects; 82% of those with migraines were stripe sensitive while only 6.2% without migraines were stripe sensitive. We conclude that stripe aversiveness is related to migraine headaches and can assist differentiation of migraine and nonmigraine headaches.
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SYNOPSIS In a retrospective survey using a standardized format, 495 patients with “primary headaches” (classic migraine, common migraine, tension headaches, and mixed headaches) were questioned about the role of the seasons and of weather changes in influencing the frequency of their headache attacks. Seasonal influences were more prominent in migraine than in the other headache syndromes, and spring exacerbetions were particularly characteristic of classic migraine. On the other hand, rapid atmospheric variations (quick weather changes) were more potent as headache triggers in mixed headaches than in classic migraine or tension headaches. These differences assist in the delineation of classic migraine as an individual entity.
Primary headache
Migraine Disorders
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Although people with migraine are aware of their headaches they are often not aware that they have migraine. This can lead to inappropriate or ineffective use of treatments, delays in seeking appropriate care, and miscommunication during clinical encounters. This article assesses self-recognition of migraine and identifies terms used by migraine sufferers to describe their migraine headaches. Individuals were selected for telephone interview by random digit dialing in several large United States cities as a part of a clinical trials recruiting initiative. Individuals (n = 30,758) aged 18 to 65 years of age were interviewed about their headaches using a validated computer-assisted telephone interview. Among the 23,564 respondents who reported headache, their headaches were classified as migraine (with or without aura) by the criteria of the International Headache Society (IHS). The relationships among the terms subjects used for their headaches and their IHS diagnosis of migraine were assessed. Of the 23,564 respondents, 4,967 individuals called their headache migraine and 3,074 individuals reported headache that met the IHS criteria for migraine. The positive predictive value for self-assessed migraine is 33.1%; the negative predictive value for a self-assessment other than migraine is 92.3%. Therefore, individuals who called their headaches migraine were about three times more likely to meet IHS criteria for migraine. Among the 3,074 individuals meeting IHS criteria for migraine, only 53.4% recognized their headaches as migraine (sensitivity 54%; specificity 83.8%). Among migraineurs, stress headaches (n = 345) and sinus headaches (n = 365) were the most common erroneous labels reported. Age influenced the erroneous terminology. Individuals less than 40 years of age were more likely to misidentify their migraine as stress headaches, whereas individuals 40 years of age and older were more likely to misidentify their migraines as sinus headaches. In a population sample, 54% of individuals with IHS migraine did not know that their headaches are migraine. Those who called their headaches migraine were much more likely to have migraine. Migraine awareness programs that rely solely on the term "migraine" may miss individuals who urgently need to be reached. Therefore, public education should target people with severe or disabling headache and aim to create awareness of the diagnostic possibilities.
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Migraine is an important issue in primary care medicine because surveys in North America consistently show that about 6% of men and 18% of women experience these recurrent and often debilitating headaches. Of those identified by surveyors as having migraine, only about 60% had consulted a physician about their headaches, and less than half of these patients reported having received a medical diagnosis of migraine.
Migraine Disorders
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Since 1966, there have been numerous reports regarding the prophylactic use of various β-receptor-blocking drugs in preventing as well as treating migraine headache.1-5The mechanism by which these drugs exert their therapeutic actions in patients with migraine remains unclear and has not been conclusively attributed to β-blockade. Even less well understood are the dosage and serum concentrations associated with reliable headache prophylaxis. It is not uncommon for patients with migraine taking up to 240 mg/day of propranolol hydrochloride to continue to have frequent migraine headaches. It is likely that the wide range of dosages needed to control headaches is due to variability in both the threshold concentration needed to control headaches as well as variability in the dosage needed to achieve that target concentration. We report a case in which periodic fluctuations in propranolol hydrochloride concentrations were temporally associated with the occurrence of migraine headaches.
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