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Table 21 Classification of headache in children [2]

From: Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

1.1 [G43.1b] Migraine without aura
 A. At least five attacks fulfilling criteria B-D.
 B. Headache attacks lasting 2–72 h (untreated or unsuccessfully treated)
 C. Headache at least two of the following four characteristics:
  1. unilateral location
  2. pulsating quality
  3. moderate or severe pain intensity
  4. aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)
 D. During headache at least one of the following:
  1. nausea and/or vomiting
  2. photophobia and phonophobia
 E. Not better accounted for by another ICDH-3 diagnosis
1.1 [G43.1b] migraine with aura
 Children and adults share the same diagnostic criteria
1.6.1.1 [G43.1B] Cyclical vomiting syndrome
 A. At least five attacks of intense nausea and vomiting, fulfilling criteria B and C
 B. Stereotypical in the individual patient and recurring with predictable periodicity
 C. All of the following:
  1. nausea and vomiting occur at least four times per hour
  2. attacks last for ≥1 h, up to 10 days
  3. attacks occur ≥1 week apart
 D. Complete freedom from symptoms between attacks
 E. Not attributed to another disorder
1.6.1.2 [G43.1B] Abdominal migraine
 A. At least five attacks of abdominal pain, fulfilling criteria B–D
 B. Attacks last 2–72 h when untreated or unsuccessfully treated
 C. Pain has at least two of the following three characteristics:
  1. midline location, periumbilical or poorly localized
  2. dull or “just sore” quality
  3. moderate or severe intensity
 D. At least two of the following four associated symptoms or signs:
  1. anorexia
  2. nausea
  3. vomiting
  4. pallor
 E. Complete freedom from symptoms between attacks
 F. Not attributed to another disorder
1.6.2. [G43.1B] Benign paroxysmal vertigo
 A. At least five attacks fulfilling criteria B and C
 B. Vertigo occurring without warning, maximal at onset and resolving spontaneously after minutes to hours without loss of consciousness
 C. At least one of the following five associated symptoms or signs:
  1. nystagmus
  2. ataxia
  3. vomiting
  4. pallor
  5. fearfulness
 D. Normal neurological examination and audiometric and vestibular functions between attacks
 E. Not attributed to another disorder
[G44.2] Tension-type headache
 Children and adults share the same diagnostic criteria
  1. Comments:
  2. 1. Migraine is often usually bilateral in young children; Unilateral headache typically occurs in late adolescence or early adulthood.
  3. 2. Pain location is often frontotemporal. Occipital headache in children, whether unilateral or bilateral, is rare and requires diagnostic caution as it may be due to structural lesions.
  4. 3. In young children, light and sound hypersensitivity can typically be detected by observing the children’s reaction pattern.
  5. 4. Cyclic vomiting syndrome is an exclusion diagnosis. History, clinical and neurological examination must not give rise to suspicion of other diseases. Thorough diagnostic examination is always necessary with regard to exclusion of other disease. Differential diagnoses: intermittent bowel obstruction (malrotation), kidney, liver, pancreatic disease, elevated intracranial pressure, poisoning, metabolic disease and epilepsy.
  6. 5. In abdominal migraine patient history, clinical and neurological examination should not raise suspicion of gastrointestinal or kidney disease or these disorders should be ruled out by proper examination.
  7. 6. In benign paroxysmal vertigo, especially young children cannot describe vertigo, but may be idnetified by gait difficulties. It is always important to rule out fossa posterior tumors, epilepsy and vestibular disease