Abstract
BackgroundThe International Classification of Headache Disorders diagnostic criteria for Headache Attributed to Transient Ischemic Attack (TIA) and many other secondary headaches are based primarily on the opinion of experts. The aim of this study was to field test, for the first time, the diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders, 3rd edition (ICHD-3) and in case of their weaknesses to propose new diagnostic criteria.MethodsConsecutive patients with Transient Ischemic Attack and a simultaneous control group were extensively interviewed soon after admission. Data were collected on previous headaches, headaches around the time of Transient Ischemic Attack and characteristics of the TIA using validated neurologist conducted semi-structured interview forms. The evidence of relevant infarction were excluded in patients with Transient Ischemic Attack using magnetic resonance imaging with diffusion-weighted imaging (n = 112) or computed tomography (n = 8).ResultsOne hundred twenty patients with Transient Ischemic Attack and 192 controls were included. A new type of headache occurred within 24 h in 16 (13%) of patients with Transient Ischemic Attack and in no controls, a preexisting type of headache with altered characteristics occurred in 9 (7.5%) of patients with Transient Ischemic Attack and no in controls, headache without altered characteristics occurred in 8 (6.6%) of patients with Transient Ischemic Attack and in 9 (4.6%) controls. Only 24% of the headaches in patients with Transient Ischemic Attack (8 of 33 patients) fulfilled the diagnostic criteria of International Classification of Headache Disorders-3 and no control patients. We propose new criteria fulfilled by 94% of the headaches. Specificity remained excellent as only one of 192 controls had a headache fulfilling the proposed criterion C.ConclusionsExisting diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders are too insensitive. We suggest new diagnostic criteria with high sensitivity and preserved specificity.
Highlights
At the time of development and publication of the International Classification of headache Disorders 3rd edition (ICHD-3) no studies had provided exact information about timing and clinical characteristics of the headaches attributed to transient ischemic attack (TIA) and the headaches had not been compared to a thorough diagnosis of patients’ previous headache disorders [1–8].existing diagnostic criteria for headache attributed to Transient Ischemic Attack (TIA) (ICHD-3) are based primarily on the opinion of experts rather than on published clinical evidence [9].Recently we performed an extensive prospective study of 120 consecutive patients with TIA [10]
The aim of this study was to field test, for the first time, the diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders, 3rd edition (ICHD-3) and in case of their weaknesses to propose new diagnostic criteria
Development of modified diagnostic criteria for TIA Before developing new criteria a crucial question had to be considered: which headaches do we really believe are caused by the emboli of a transient ischemic attack? It seems intuitively obvious that a new kind of headache never before encountered by the patient is highly likely to be caused by the TIA, when it starts some time after the neurological deficits
Summary
At the time of development and publication of the International Classification of headache Disorders 3rd edition (ICHD-3) no studies had provided exact information about timing and clinical characteristics of the headaches attributed to transient ischemic attack (TIA) and the headaches had not been compared to a thorough diagnosis of patients’ previous headache disorders [1–8].existing diagnostic criteria for headache attributed to TIA (ICHD-3) are based primarily on the opinion of experts rather than on published clinical evidence [9].Recently we performed an extensive prospective study of 120 consecutive patients with TIA [10]. Existing diagnostic criteria for headache attributed to TIA (ICHD-3) are based primarily on the opinion of experts rather than on published clinical evidence [9]. As part of this study we performed extensive semi-structured interviews about previous and actual headaches as soon after admission for TIA as possible. We characterised both the previous headaches and the headaches occurring around the time of TIA. The International Classification of Headache Disorders diagnostic criteria for Headache Attributed to Transient Ischemic Attack (TIA) and many other secondary headaches are based primarily on the opinion of experts. The aim of this study was to field test, for the first time, the diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders, 3rd edition (ICHD-3) and in case of their weaknesses to propose new diagnostic criteria
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