BackgroundThe International Classification of Headache Disorders diagnostic criteria for Headache Attributed to Transient Ischemic Attack (TIA) and many other secondary headaches are based primarily on the opinion of experts. The aim of this study was to field test, for the first time, the diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders, 3rd edition (ICHD-3) and in case of their weaknesses to propose new diagnostic criteria.MethodsConsecutive patients with Transient Ischemic Attack and a simultaneous control group were extensively interviewed soon after admission. Data were collected on previous headaches, headaches around the time of Transient Ischemic Attack and characteristics of the TIA using validated neurologist conducted semi-structured interview forms. The evidence of relevant infarction were excluded in patients with Transient Ischemic Attack using magnetic resonance imaging with diffusion-weighted imaging (n = 112) or computed tomography (n = 8).ResultsOne hundred twenty patients with Transient Ischemic Attack and 192 controls were included. A new type of headache occurred within 24 h in 16 (13%) of patients with Transient Ischemic Attack and in no controls, a preexisting type of headache with altered characteristics occurred in 9 (7.5%) of patients with Transient Ischemic Attack and no in controls, headache without altered characteristics occurred in 8 (6.6%) of patients with Transient Ischemic Attack and in 9 (4.6%) controls. Only 24% of the headaches in patients with Transient Ischemic Attack (8 of 33 patients) fulfilled the diagnostic criteria of International Classification of Headache Disorders-3 and no control patients. We propose new criteria fulfilled by 94% of the headaches. Specificity remained excellent as only one of 192 controls had a headache fulfilling the proposed criterion C.ConclusionsExisting diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders are too insensitive. We suggest new diagnostic criteria with high sensitivity and preserved specificity.

中文翻译：

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短暂性脑缺血发作引起的头痛的新诊断标准

背景 由短暂性脑缺血发作 (TIA) 引起的头痛和许多其他继发性头痛的头痛疾病国际分类诊断标准主要基于专家的意见。本研究的目的是首次现场测试国际头痛疾病分类第 3 版 (ICHD-3) 中 TIA 的头痛诊断标准，并在其弱点的情况下提出新的诊断标准。方法在入院后不久对一过性脑缺血发作的连续患者和同期对照组进行广泛访谈。使用经过验证的神经科医生进行的半结构化访谈表格收集了有关先前头痛、短暂性脑缺血发作前后的头痛和 TIA 特征的数据。使用磁共振成像和弥散加权成像（n = 112）或计算机断层扫描（n = 8）排除短暂性脑缺血发作患者相关梗死的证据。结果 120 名短暂性脑缺血发作患者和 192 名对照者被纳入。16 名 (13%) 短暂性脑缺血发作患者在 24 小时内出现了一种新型头痛，没有对照组，9 名 (7.5%) 短暂性脑缺血发作患者出现了具有改变特征的先前存在的头痛类型，没有在对照组中，8 名 (6.6%) 短暂性脑缺血发作患者和 9 名 (4.6%) 对照组患者出现了没有改变特征的头痛。短暂性脑缺血发作患者（33 名患者中的 8 名）中，只有 24% 的头痛符合国际头痛疾病分类 3 的诊断标准，没有对照患者。我们提出了 94% 的头痛满足的新标准。特异性仍然非常好，因为 192 名对照中只有 1 名的头痛符合提议的标准 C。结论 现有的头痛疾病国际分类 TIA 引起的头痛诊断标准过于不敏感。我们建议具有高灵敏度和保留特异性的新诊断标准。结论 现有的国际头痛疾病分类中 TIA 所致头痛的诊断标准过于不敏感。我们建议具有高灵敏度和保留特异性的新诊断标准。结论 现有的国际头痛疾病分类中 TIA 所致头痛的诊断标准过于不敏感。我们建议具有高灵敏度和保留特异性的新诊断标准。