Headache ISSN 0017-8748 C  2006 by American Headache Society doi: 10.1111/j.1526-4610.2006.00372.x Published by Blackwell Publishing Research Submission Clinical Characteristics of Tension-Type Headache and Migraine in Adolescents: A Student-Based Study Necdet Karlı, MD; Semra Akg ¨ oz, MD, MPH, PhD; Mehmet Zarifo˘ glu, MD; Nalan Akı¸ s, MD; Sevda Erer, MD Background and objectives.—Adolescent headaches, particularly migraine, might present with different fea- tures from adult headaches. The objectives of this study were to investigate the characteristics of tension-type headache and migraine, to find the sensitivity and specificity of the diagnostic criteria of the IHS classification according to age and gender. Methods.—A multistep, stratified, cluster sampling method was used for subject selection. The estimated sample size was 2387. The study was conducted in two phases: the questionnaire and the face to face interview phases. During the semistructured interview, a clinical diagnosis has been made and clinical characteristics have been recorded. Results.—All headaches fulfilled the criteria of duration. The most common feature of migraine was moderate to severe (92.4%), pulsating pain (79.2%). For ETTH, bilateral localization (91.3%) and mild to moderate pain intensity (90.6%) were the most common features. Younger adolescents showed mixed headache characteristics. Highest sensitivities for migraine were duration (100%), moderate to severe pain (92.4%), and pulsating quality of pain (79.2%). Vomiting, trigger factors food and alcohol had a high specificity for migraine. Conclusions.—Our data strongly support continuum hypothesis. In early adolescence headaches might present with mixed headache characteristics. Age and gender have some influence on headache characteristics, particularly on migraine. The sensitivity and specificity of case definition criteria of ICHD-2 for adolescent migraine is moderate and need to be reconsidered. Key words: adolescent, migraine, tension-type headache, clinical characteristics, IHS criteria Abbreviations: TTH tension-type headache, ETTH episodic tension-type headache, IHS international headache society, ICHD International classification of headache disorders, CTTH chronic tension-type headache, MWoA migraine without aura, MWA migraine with aura (Headache 2006;46:399-412) From the University of Uludag, School of Medicine, Depart- ment of Neurology, Bursa, Turkey (Drs. Karlı, Zarifo˘ glu, and Erer); University of Uludag, School of Medicine, Department of Biostatistics, Bursa, Turkey (Dr. Akg¨ oz); University of Uludag, School of Medicine, Department of Public Health, Bursa, Turkey (Dr. Akıs ¸). Address all correspondence to Dr. Necdet Karlı , University of Uludag, School of Medicine, Department of Neurology, 16059 Gorukle/Bursa, Turkey. Accepted for publication August 22, 2005. Headache is a prevalent disorder of the childhood and adolescence. Reported prevalence rates for all types of headache in children and adolescents ranged from 19.5% to 93.3%, where prevalence of tension- type headache (TTH) was between 0.9% to 72.3% TTH) and 2.97% to 28% for migraine. 1-9 The wide range of prevalence depends on many factors. Method- ological differences such as study population selec- tion, age and gender selection, differing diagnostic cri- teria, geographical differences of the study location, 399