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Three Part Question

In a [child who present to the emergency department] is a [headache diary] useful for the [diagnosis of migraine].

Clinical Scenario

A 13 year old child presents with a bilateral severe throbbing headache to the emergency department with her mother. She came to the emergency department 2 months ago complaining of the same type of headache but of moderate intensity. At that time she explained that the headaches started a month before attending the emergency department. She was referred to the head specialist and was given a headache diary to fill in. You look at the headache diary and see that headaches last on average for one and a half hours, are associated with nausea and vomiting and are relieved by sleep. You wonder whether the headache diary is useful in making the diagnosis of migraine.

Search Strategy

Medline 1950-June 2007 using Ovid Interface
Embase 1980 to 2007 Week 26 using Ovid Interface
[(headache diary.mp. OR headache chart.mp. OR headcahe record.mp.) AND (exp symptoms OR exp clinical features Or exp.diagnosis) AND (exp headache OR exp migraine OR exp migraine OR exp migraine without aura OR exp migraine with aura OR exp migraine aura) AND (LIMIT to children)]

Search Outcome

9 papers were identified on Embase of which 1 was relevant and 9 papers were found on medline of which 0 were relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Metsahonkala et al, 1997 Finland	5356 children followed up from birth to 13 years of age, only 145 children studied for clarification of migraine.	Follow up	Number of children with migraine	72 children according to International Headache Society for migraine either in the headache diary or the interview.	Some children were incapable of filling in the diary. Inaccuracies occurred in reporting the end point of the headache episode. Follow up period was too short.
			Children diagnosed with migraine	8 children, 11.1% were diagnosed with migraine using the headache diary alone.
			Migraine attacks and non migrainous episodes	Thirty-three children had both migraine attacks and non migrainous headache episodes according to the diary, even though they were able to report only one type of headache episode in the interview.
			Duration of headache episodes	Underestimated in the interview compared to the headache diary.
			New symptoms recognised with diary	New aura symptoms, associated symptoms, characteristics of pain.
			Symptoms reported in diary	9 children reported aura symptoms in the diary which had not been reported in the interview. Headache episode duration in the diary was longer than that of the interview
			Frequency of headaches	There was no difference between reported frequency of headaches in the diary or in the interview.
			Consistency of diary data with interview	There was consistency in 60.8% of children.

Comment(s)

The study is not specific to the emergency department.

Clinical Bottom Line

A headache diary is useful in the diagnosis of migraine, since many patients are unable to report accurately what they had experienced in their previous migraine attacks if left to rely on memory. Some patients become confused or lose concentration during their migraine episode so therefore may not be able to recall what happened in that episode if asked 2 weeks later.

References

1. Metsahonkala L. Sillanpaa M. Tuominen J. Headache diary in the diagnosis of childhood migraine. Headache 240-244, 1997.