Prospective testing of ICHD-3 beta diagnostic criteria for migraine with aura and migraine with typical aura in patients with transient ischemic attacks

Introduction: The International Classification of Headache Disorders 3rd edition beta (ICHD-3 beta) gave alternative diagnostic criteria for 1.2 migraine with aura (MA) and 1.2.1 migraine with typical aura (MTA) in the appendix. The latter were presumed to better differentiate transient ischemic attacks (TIA) from MA. The aim of the present study was to field test that. Methods: Soon after admission, a neurologist interviewed 120 consecutive patients diagnosed with TIA after MRI or CT. Semi-structured interview forms addressed all details of the TIA episode and all information necessary to apply the ICHD-3beta diagnostic criteria for 1.2, 1.2.1, A1.2 and A1.2.1. Results: Requiring at least one identical previous attack, the main body and the appendix criteria performed almost equally well. But requiring only one attack, more than a quarter of TIA patients also fulfilled the main body criteria for 1.2. Specificity was as follows for one attack: 1.2: 0.73, A1.2: 0.91, 1.2.1: 0.88 and A1.2.1: 1.0. Sensitivity when tested against ICHD-2 criteria were 100% for the main body criteria (because they were unchanged), 96% for A1.2 and 94% for A1.2.1. Conclusion: The appendix criteria performed much better than the main body criteria for 1.2 MA and 1.2.1 MTA when diagnosing one attack (probable MA). We recommend that the appendix criteria should replace the main body criteria in the ICHD-3.