title: Tension-type headache or migraine? Adolescents' pain descriptions are of little help.
abstract: OBJECTIVE
  The aim of this study was to investigate the utility of pain descriptors (pain quality, pain intensity) assessed in a questionnaire to discriminate tension-type headache (TTH) from TTH plus migraine in a sample of adolescents.
  
  
  BACKGROUND
  Epidemiological studies assess pain characteristics via questionnaire and estimate prevalence rates based on these pain descriptions. According to International Headache Society criteria, the subjective pain quality and intensity for TTH and migraine differs and therefore should be able to discriminate the 2 diagnoses. The discriminative ability between TTH and TTH plus migraine may be a special challenge.
  
  
  METHODS
  One hundred twenty-two adolescents with pure TTH and 110 adolescents with TTH plus migraine aged 11-18 years presenting to a tertiary pediatric pain clinic were included in the study. Questionnaire reports of pain intensity and quality were compared with physician's diagnosis as the gold standard. Mean differences as well as receiver operating characteristics were analyzed.
  
  
  RESULTS
  Adolescents with TTH plus migraine reported more pulsating and less intense pain compared with pure TTH. Receiver operating characteristic analysis indicated that pain descriptors did not discriminate between groups. Diagnostic utility of descriptors was similarly low for older adolescents and parental proxy reports.
  
  
  CONCLUSIONS
  Pain intensity and quality assessed by questionnaires are not suitable to discriminate TTH from TTH plus migraine. This may lead to inaccurate prevalence estimates in epidemiological studies and may mislead practitioners in forming diagnostic hypotheses. The exclusion of these pain descriptors in questionnaires should be considered. More research systematically assessing the diagnostic utility of verbal pain descriptors in primary care and epidemiological samples is needed.
authors: German Paediatric Pain Centre and Department of Children's Pain Therapy and Paediatric Palliative Care, Children's and Adolescents' Hospital, Datteln, Witten/Herdecke University, Witten/Herdecke, Germany. j.wager@kinderklinik-datteln.de
authors: Julia
authors: J
authors: Wager
authors: Gerrit
authors: G
authors: Hirschfeld
authors: Boris
authors: B
authors: Zernikow
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000523:psychology*; D010147:Pain Measurement; D058748:Pain Perception / Q000502:physiology*; D017288:Pain Threshold / Q000502:physiology*; D012372:ROC Curve; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D018781:Tension-Type Headache / Q000175:diagnosis / Q000523:psychology*