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Sensitivity and specificity of the new international diagnostic criteria for migraine with aura

Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Copenhagen, Denmark

Correspondence to:
Correspondence to:
Dr M K Eriksen
Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark; kirchmann{at}dadlnet.dk

Objectives: Since 1998, migraine with aura (MA) has been diagnosed according to the operational diagnostic criteria of the International Headache Society (ICHD-1). Here we present the data underlying the new criteria for MA in the ICHD-2 classification.

Methods: Sensitivity of the new criteria was tested in patients with MA and specificity in patients with reversible non-aura visual disturbances. The diagnoses in both groups of patients were made in a validated semistructured physician-conducted interview. We tested five sets of criteria for sensitivity and specificity comparing with the diagnosis according to the ICHD-1 in 200 patients and the selected set of criteria in 274 additional patients.

Results: Four sets of criteria had sensitivity/specificity of 46%/100%, 71%/100%, 62%/95%, and 99%/76%. Sensitivity of the selected set of criteria was 84% (95% CI 79% to 90%) and specificity 97% (95% CI 95% to 99%). According to these criteria at least two of the following should be fulfilled: homonymous visual or unilateral sensory symptoms; at least one aura symptom develops gradually over 5 minutes and/or different symptoms occur in succession over 5 minutes; each symptom lasts 5 and 60 minutes. In the additional sample sensitivity of the selected criteria was 90% (95% CI 86% to 94%) and specificity 96% (95% CI 91% to 100%).

Conclusions: The diagnostic criteria for MA selected for ICHD-2 had high sensitivity and specificity. The ICHD-2 criteria are more operational and probably delineate a more homogeneous sample of patients than the ICHD-1. The ICHD-2 for MA is intended equally for research and clinical practice and can be used at different levels of specialisation.

Abbreviations: ICHD, International Classification of Headache Disorders; MA, migraine with aura

Keywords: migraine with aura; classification; diagnostic criteria

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