Chronic Migraine and Medication Overuse Headache: Clarifying the Current International Headache Society Classification Criteria

Cephalalgia ◽  
2009 ◽  
Vol 29 (4) ◽  
pp. 445-452 ◽  
Author(s):  
C Sun-Edelstein ◽  
ME Bigal ◽  
AM Rapoport
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Classification Criteria ◽  
Daily Headache ◽  
Considerable Controversy ◽  
Chronic Daily Headaches ◽  
International Headache Society Classification

Despite the recent advances in the understanding and classification of the chronic daily headaches, considerable controversy still exists regarding the classification of individual headaches, including chronic migraine (CM) and medication overuse headache (MOH). The original criteria, published in 2004, were difficult to apply to most patients with these disorders and were subsequently revised, resulting in broader clinical applicability. Nonetheless, they remain a topic of debate, and the revisions to the criteria have further added to the confusion. Even some prominent headache specialists are unsure which criteria to use. We aimed to explain the nature of the controversies surrounding the entities of CM and MOH. A clinical case will be used to illustrate some of the problems faced by clinicians in diagnosing patients with chronic daily headache.

The International Classification of Headache Disorders Revised Criteria for Chronic Migraine—Field Testing in a Headache Specialty Clinic

Cephalalgia ◽  
2007 ◽  
Vol 27 (3) ◽  
pp. 230-234 ◽  
Author(s):  
ME Bigal ◽  
AM Rapoport ◽  
FD Sheftell ◽  
SJ Tepper ◽  
RB Lipton
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Biological Marker ◽  
International Classification ◽  
Headache Disorders ◽  
Transformed Migraine ◽  
Probable Migraine

In the absence of a biological marker and expert consensus on the best approach to classify chronic migraine (CM), recent revised criteria for this disease has been proposed by the Headache Classification Committee of the International Headache Society. This revised criteria for CM is now presented in the Appendix. Herein we field test the revised criteria for CM. We included individuals with transformed migraine with or without medication overuse (TM+ and TM-), according to the criteria proposed by Silberstein and Lipton, since this criterion has been largely used before the Second Edition of the International Classification of the Headache Disorders (ICHD-2). We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+), as well as the revised ICHD-2 (ICHD-2R) criteria for CM (≥15 days of headache, ≥8 days of migraine or migraine-specific acute medication use—ergotamine or triptans). We also tested the ICHD-2R vs. three proposals. In proposal 1, CM/CM+ would require at least 15 days of migraine or probable migraine per month. Proposal 2 required ≥15 days of headache per month and at least 50% of these days were migraine or probable migraine. Proposal 3 required ≥15 days of headache and at least 8 days of migraine or probable migraine per month. Of the 158 patients with TM-, just 5.6% met ICHD-2 criteria for CM. According to the ICHD-2R, a total of 92.4% met criteria for CM ( P < 0.001 vs. ICHD-2). The ICHD-2R criterion performed better than proposal 1 (47.8% of agreement, P < 0.01) and was not statistically different from proposals 2 (87.9%) and 3 (94.9%). Subjects with TM+ should be classified as medication overuse headache (MOH), and not CM+, according to the ICHD-2R. Nonetheless, we assessed the proportion of them who had ≥8 days of migraine per month. Of the 399 individuals with TM+, just 10.2% could be classified as CM+ in the ICHD-2. However, most (349, 86.9%) had ≥8 days of migraine per month and could be classified as MOH and probable CM in the ICHD-2R ( P < 0.001 vs. ICHD-2). We conclude that the ICHD-2R addresses most of the criticism towards the ICHD-2 and should be adopted in clinical practice and research. In the population where use of specific acute migraine medications is less common, the agreement between ICHD-2R CM and TM may be less robust.

The International Headache Society Classification of Chronic Daily and Near-Daily Headaches

Cephalalgia ◽  
1996 ◽  
Vol 16 (6) ◽  
pp. 407-411 ◽  
Author(s):  
J Olesen ◽  
BK Rasmussen
Keyword(s):  
Chronic Daily Headache ◽  
International Headache Society ◽  
Sudden Onset ◽  
Hemicrania Continua ◽  
Transformed Migraine ◽  
Ihs Classification ◽  
Daily Headache ◽  
Future Revision ◽  
International Headache Society Classification

The classification of the International Headache Society (IHS) published in 1988 has been positively received throughout the world. However, the classification of headaches occurring daily or almost daily has been criticized repeatedly. This criticism is discussed in the present review. It is possible to classify virtually all chronic headache patients using the IHS Classification and there seems to be more need for emphasizing a correct application of the classification than for a revision in this regard. The entity of transformed migraine is disputed and so is the existence of hemicrania continua. Neither of these syndromes has been adequately defined nor studied. Chronic daily headache of sudden onset (new persistent daily headache) is not adequately classified at present and should be included as a separate entity in the next edition of the IHS Classification. In a future revision it should also be possible to classify drug-related headache simply on the basis of drug consumption and without mandatory demands for withdrawal. Better longitudinal studies of patients with chronic daily headache are necessary to evaluate finally whether a revision of the classification of these headache syndromes is necessary. Eventually the ongoing discovery of migraine genes is likely to change radically the classification of migraine.ÿ

Chronic Migraine and Medication-Overuse Headache Through the Ages

Cephalalgia ◽  
2005 ◽  
Vol 25 (5) ◽  
pp. 378-390 ◽  
Author(s):  
CJ Boes ◽  
DJ Capobianco
Keyword(s):  
Chronic Migraine ◽  
English Language ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Headache Frequency ◽  
Ihs Criteria ◽  
Acute Headache

We set out to review early descriptions of chronic migraine and medication-overuse headache. The International Headache Society (IHS) recently gave criteria for chronic migraine and medication-overuse headache. Chronic migraine was absent from the 1988 IHS criteria. Peters and Horton described ergotamine-overuse headache in 1951. In the 1980s it was more fully appreciated that overuse of other acute headache medications could increase headache frequency. We reviewed published English-language papers and book chapters. Willis (1672), Oppenheim (1900), Collier (1922), Balyeat (1933), and von Storch (1937) all described chronic migraine. Lennox (1934), O'Sullivan (1936), Silfverskiöld (1947), Graham (1955), Friedman (1955), and Lippman (1955) wrote about ergotamine-overuse headache. Graham (1955), Friedman (1955), Lippman (1955), and Horton and Peters (1963) outlined withdrawal protocols. Chronic migraine has been mentioned in the literature for centuries, while medication-overuse headache has been written about for decades. Graham, Friedman, and Lippman deserve credit for separately reporting the first ergotamine withdrawal programmes.

scholarly journals Clinical features of medication overuse headache following overuse of different acute symptomatic medications: A preliminary study

2021 ◽  
Author(s):  
Sun-Young Oh ◽  
Jin-Ju Kang ◽  
Hong-Kyun Park ◽  
Soo-Jin Cho ◽  
Min Kyung Chu
Keyword(s):  
Clinical Features ◽  
Clinical Characteristics ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Observation Study ◽  
Cross Sectional ◽  
Daily Headache ◽  
Multiple Drugs ◽  
Acute Headache

Abstract Background Medication overuse headache (MOH) is a growing problem worldwide and is defined as daily or near-daily headache in patients with a primary headache disorder who overuse acute medications. There is debate about whether there are differences in the clinical features and risks of MOH induced by different drugs. Here we investigated the clinical characteristics of patients with MOH following overuse of different acute headache drugs such as triptans and other medications.Methods A multicenter cross-sectional observation study, REgistry for Load and Management of MEdicAtion OveruSE Headache (RELEASE), prospectively collected demographic and clinical data from 114 consecutive patients with MOH according to the International Headache Society criteria between May 2020 and January 2021. We calculated the mean duration until onset of MOH from chronic daily headache (MDMOH), mean monthly frequency of severe headache (MMFSH), mean monthly frequency of seeking medical services (MMFMedS), and mean monthly intake frequency (MMIF) as well as headache impact and neuropsychological tests in patients with MOH after overuse of acute headache drugs.Results A total of 105 eligible MOH patients was included in this study. The patients showed overuse of triptans (31/105, 29.5%), ergotamines (8/105, 7.6%), simple or combination analgesics (37/105, 35.2%), opioids (1/105, 0.9%), and combination of two of more drugs (28/105, 26.7%). The MDMOH was significantly longer for the analgesics group (10.6 years) than the ergotamines (4.1 years), triptans (4.3 years), or multiple drugs group (4.8 years) (p = 0.011, Kruskal–Wallis test). The MMFMedS was lower for the analgesics group (0.37 days per month) than the multiple drugs (0.85 days) or triptans (0.58 days) group (p = 0.008, Kruskal–Wallis test). The MMFSH was significantly lower in the triptans group (7.4 days per month) than in the analgesics (14.4 days) or multiple drugs group (13.7 days) (p = 0.005, Kruskal–Wallis test). The MMIF was higher in the multiple drugs group (25 days per month) than the triptans (18.1 days) or analgesics (19.5 days) group (p = 0.007, Kruskal–Wallis test).Conclusion Data from this prospective multicenter study suggest that the clinical characteristics of MOH depend on the type of overused symptomatic headache medications.

Medication Overuse Headache and Chronic Migraine in a Specialized Headache Centre: Field-Testing Proposed New Appendix Criteria

Cephalalgia ◽  
2009 ◽  
Vol 29 (2) ◽  
pp. 214-220 ◽  
Author(s):  
P Zeeberg ◽  
J Olesen ◽  
R Jensen
Keyword(s):  
Chronic Migraine ◽  
Pain Perception ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Field Testing ◽  
Tension Type Headache ◽  
Main Body ◽  
Headache Centre ◽  
Type Headache

The classification subcommittee of the International Headache Society (IHS) has recently suggested revised criteria for medication overuse headache (MOH) and chronic migraine (CM). We field tested these revised criteria by applying them to the headache population at the Danish Headache Centre and compared the results with those using the current criteria. For CM we also tested two alternative criteria, one requiring ≥ 4 migraine days/month and ≥ 15 headache days/month, the second requiring ≥ 15 headache days/month and ≥ 50% migraine days. We included 969 patients with migraine or tension-type headache (TTH) among 1326 patients treated and dismissed in a 2-year period. Two hundred and eighty-five patients (30%) had TTH, 265 (27%) had migraine and 419 (43%) had mixed migraine and TTH. The current criteria for MOH classified 86 patients (9%) as MOH, 98 (10%) as probable MOH and 785 (81%) as not having MOH after a 2-month drug-free period. Using the appendix criteria, 284 patients (29%) were now classified as MOH, no patients as probable MOH and 685 (71%) as not having MOH. For CM only 16 patients (3%) fulfilled the current diagnostic criteria. This increased to 42 patients (7%) when we applied the appendix criteria. Using the less restrictive criteria of ≥ 4 migraine days and ≥ 15 headache days, 88 patients (14%) had CM, whereas the more restrictive criteria of ≥ 15 headache days and ≥ 50% migraine days resulted in 24 patients (4%) with CM. Our data suggest that the IHS has succeeded in choosing new criteria for CM which are neither too strict, nor too loose. For MOH, a shift to the appendix criteria will increase the number of MOH patients, but take into account the possibility of permanent changes in pain perception due to medication overuse and the possibility of a renewed effect of prophylactic drugs due to medication withdrawal. We therefore recommend the implementation of the appendix criteria for both MOH and CM into the main body of the International Classification of Headache Disorders.

Field Testing Alternative Criteria for Chronic Migraine

Cephalalgia ◽  
2006 ◽  
Vol 26 (4) ◽  
pp. 477-482 ◽  
Author(s):  
ME Bigal ◽  
SJ Tepper ◽  
FD Sheftell ◽  
AM Rapoport ◽  
RB Lipton
Keyword(s):  
Chronic Migraine ◽  
Chronic Daily Headache ◽  
Medication Overuse ◽  
Field Testing ◽  
Episodic Migraine ◽  
Headache Disorders ◽  
Transformed Migraine ◽  
Daily Headache ◽  
Probable Migraine

The criteria for chronic migraine (CM), as proposed by the Second Edition of the International Classification of Headache Disorders (ICHD-2) is very restrictive, excluding most patients that evolve from episodic migraine. In this study we empirically tested three recent proposals for revised criteria for CM. We included individuals with transformed migraine (TM) with or without medication overuse, according to the criteria proposed by Silberstein and Lipton. All individuals had headache calendars for at least three consecutive months. We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+). We also tested three proposals for making the CM criteria more inclusive. In proposal 1, CM/CM+ would require at least 15 days of migraine or probable migraine per month. Proposal 2 suggests that CM/CM+ would be classified in those with ≥15 days of headache per month, where at least 50% of these days are migraine or probable migraine. Proposal 3 suggests that CM/CM+ would be classified in those with chronic daily headache and at least 8 days of migraine or probable migraine per month. Among TM sufferers, 399 (62.5%) had TM with medication overuse, and just 10.2% were classified as CM+ 158 (37.5%) had TM without medication overuse; just nine (5.6%) met current ICHD-2 criteria for CM. Using the alternative criteria, proposal 1 included 48.7% of patients with TM without medication overuse; proposal 2 captured 88%, and proposal 3 classified 94.9% of these patients. For TM with medication overuse, the proportions for proposals 1-3 were, respectively, 37%, 81% and 91%. The differences were statistically significant, favouring proposal 3. Consistently, criteria for CM and CM+ should be revised to require at least 8 days of migraine or probable migraine per month, in individuals with 15 or more days of headache per month.

New Appendix Criteria Open for a Broader Concept of Chronic Migraine

Cephalalgia ◽  
2006 ◽  
Vol 26 (6) ◽  
pp. 742-746 ◽  
Author(s):  
J Olesen ◽  
M-G Bousser ◽  
H-C Diener ◽  
D Dodick ◽  
M First ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Ergot Alkaloids ◽  
Primary Headache ◽  
Scientific Evaluation ◽  
Combined Use ◽  
International Headache Classification ◽  
New Criteria

After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.

Chronic Daily Headache in A Tertiary Care Population: Correlation Between the International Headache Society Diagnostic Criteria and Proposed Revisions of Criteria for Chronic Daily Headache

Cephalalgia ◽  
2002 ◽  
Vol 22 (6) ◽  
pp. 432-438 ◽  
Author(s):  
ME Bigal ◽  
FD Sheftell ◽  
AM Rapoport ◽  
RB Lipton ◽  
SJ Tepper
Keyword(s):  
Chronic Migraine ◽  
Chronic Daily Headache ◽  
International Headache Society ◽  
Tertiary Care ◽  
Tension Type Headache ◽  
Classification Systems ◽  
Common Diagnosis ◽  
Ihs Classification ◽  
Daily Headache

The International Headache Society (IHS) has been criticized for its approach to classification of chronic daily headache (CDH); Silberstein and Lipton criteria provide an alternative to this approach. The aim of this study is to apply the alternative diagnostic approaches to a sample of CDH patients consulting in specialty care. Our sample consisted of 638 patients with CDH. Patients were classified according to both classification systems. Patients were predominantly female (65.0%), with ages ranging from 11 to 88 years. According to the Silberstein and Lipton classification, we found eight different diagnoses. The most common diagnosis was chronic migraine (87.4%), followed by new daily persistent headache (10.8%). Just six patients had chronic tension- type headache (CTTH). Applying the IHS criteria we found 14 different diagnoses. Migraine was found in 576 (90.2%) patients. CTTH occurred in 621 (97.3%), with only 10 (1.57%) having this as the sole diagnosis. We conclude that both systems allow for the classification of most patients with CDH when daily headache diaries are available. The main difference is that the IHS classification is cumbersome and requires multiple diagnoses. The Silberstein and Lipton system is easier to apply, and more parsimonious. These findings support revision of the IHS classification system to include chronic migraine.

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