Cefalee: la classificazione ICHD-3
Presentiamo qui in anteprima l’abstract dell’intervento del dr. Ishaq Abu-Arafeh (NHS Greater Glasgow and Clyde, Glasgow UK), tra i relatori del XXXII Corso di aggiornamento della FM “Cefalee ed emicrania in età evolutiva: dalla diagnosi alle terapie” in programma a Pavia dal 5 al 7 marzo 2020. Il dr. Abu-Arafeh, chairman del ‘Child and Adolescent Standing Committee’ della International Headache Society, illustrerà le specificità per l’età evolutiva della Classificazione ICHD-3 (International Classifications of Headache Disorders), lo strumento più completo per la comprensione di questo tipo di disturbi, giunto ormai alla sua terza edizione.
The International Classifications of Headache Disorders, now in its 3rd edition, is the most comprehensive and detailed document that helped clinicians and researchers in better understanding the various headache disorders over the past 30 years. Despite its good applicability to people with most types of headache across the world, the document needs a continuous update and improvement especially in the field of pediatrics. It is conceivable that headache disorders in children have the same etiology and pathogenesis as in adults, but it is also well recognized that disease expression, clinical presentation and response to treatment may vary according to age of patients and most clearly in childhood.
Headache disorders are classified into 3 major types on basis of etiology into primary, secondary and undetermined. Primary headache disorders are further classified on the basis of clinical presentation with clinical criteria for diagnosis into migraine, tension-type headache and TAC’s. Secondary headaches and headaches of and undetermined etiology are further sub-classified on etiology and clinical features. A third axis of classification is based on frequency of attacks and duration of the headache disorders into episodic (frequent or infrequent) if attacks occur on less than 15 days per month or chronic if attacks occur on at least 15 days per month over at least 3 consecutive months.
The three axes of classification are as applicable to children as to adults, but with special attention to the criteria for diagnoses of different types of headache in children. Important modifications should be considered in order to make the diagnostic criteria meaningful in pediatrics and in particular, the ability of the child to estimate length of time, ability in the use of language, interpretation of child’s behavior during attacks, impact of headache on school and family life and the roles of parents and carers in child’s life.
Migraine can present in several different phenotypes that are more specific or more likely to occur in children such as Alice in Wonderland syndrome with intense and complex visual aura and other migraine related syndromes. Trigeminal autonomic cephalalgias are often atypical in clinical presentation and are less likely to respond to treatments described in adults.
Taking a focused clinical history of headache in children requires special skills in allowing children to use their own language and words in describing headache and also in the interpretation of their behaviour during attacks or allowing them to make drawings.