Evaluation of the diagnostic value of clinical characteristics and situations associated with primary headache in children: International classification of headache Disorders-3 edition

•Migraine is the most common chronic headache disorder in childhood and is diagnosed clinically.•A family history of migraine and a longer duration of headache may be used for the diagnosis of migraine in children.•The diagnostic power of ICHD-3 headache criteria should be increased in pediatric cases. In the childhood period, diagnosis of primary headache is based on anamnesis essentially. This study investigated the effects of characteristics of headache (type of pain, localization and attack time), family migraine history and total duration from onset of headache to clinical diagnosis on primary headache diagnosis. Headache history was taken from children aged 6–18 years with a suitable form of International Classification of Headache Disorders, 3rd edition. Children's demographic findings were recorded. Headache characteristics (type of pain, localization and attack time), whether there is family migraine history and total duration from onset of headache to clinical diagnosis were recorded and sensitivity and specificity were calculated. The effects of pulsatile pain, forehead localization, attack time ≥2 h, family history of migraine and total time from onset of headache to clinical diagnosis on final diagnosis of primary headache (migraine without aura or others) were also assessed with regression analysis. Of a total of 277 patients, 52 % were diagnosed with migraine without aura. Regression analysis revealed that family history of migraine was the most determinant factor for migraine without aura diagnosis (OR 2.922, 95 %CI 1.622–5.264). This was followed by the pursuing risk coefficients for migraine without aura diagnosis in order of forehead localization (OR 2.751, 95 %CI 1.537–4.923), attack time of ≥2 h (OR 2.615, 95 %CI 1.406–4.864), nausea (OR 2.163, 95 %CI 1.192–3.924), pulsatile pain (OR 2.102, 95 %CI 1.185–3.729) and total duration (OR 1.973, 95 %CI 1.105–3.521). Family history of migraine and total duration of longer than 6 months from onset of headache to clinical diagnosis may be additional markers for migraine without aura diagnosis. Due to difficulties experienced in diagnosis of primary headache based on anamnesis in the childhood period, there is a need for additional diagnostic markers.