Proposals for New Standardized General Diagnostic Criteria for the Secondary Headaches

Cephalalgia ◽  
2009 ◽  
Vol 29 (12) ◽  
pp. 1331-1336 ◽  
Author(s):  
J Olesen ◽  
T Steiner ◽  
M-G Bousser ◽  
H-C Diener ◽  
D Dodick ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Good News ◽  
Secondary Headache ◽  
Main Body ◽  
Headache Classification ◽  
Secondary Headaches ◽  
The Many

Headache classification is a dynamic process through clinical testing and re-testing of current and proposed criteria. After publication of the second edition of the International Classification of Headache Disorders (ICHD-II), need arose for revisions in the classification of medication overuse headache and chronic migraine. These changes made apparent a further need for broader revisions to the standard formulation of diagnostic criteria for the secondary headaches. Currently, the fourth criterion makes impossible the definitive diagnosis of a secondary headache until the underlying cause has resolved or been cured or greatly ameliorated by therapy, at which time the headache may no longer be present. Given that the main purpose of diagnostic criteria is to enable a diagnosis at the onset of a disease in order to guide treatment, this is unhelpful in clinical practice. In the present paper we propose maintaining a standard approach to the secondary headaches using a set of four criteria A, B, C and D, but we construct these so that the requirement for resolution or successful treatment is removed. The proposal for general diagnostic criteria for the secondary headaches will be entered into the internet-based version of the appendix of ICHD-II. During 2009 the Classification Committee will apply the general criteria to all the specific types of secondary headaches. These, and other changes, will be included in a revision of the entire classification entitled ICHD-IIR, expected to be published in 2010. ICHD-IIR will be printed and posted on the website and will be the official classification of the International Headache Society. Unfortunately, it will be necessary to translate ICHD-IIR into the many languages of the world, but the good news is that no major changes to the headache classification are then foreseen for the next 10 years. Until the printing of ICHD-IIR, the printed ICHD-II criteria remain in place for all other purposes. We issue a plea to the headache community to use and study these proposed general criteria for the secondary headaches in order to provide more evidence for their utility—before their incorporation in the main body of the classification.

Development of diagnostic criteria for headache syndromes: Lessons from psychiatry

Cephalalgia ◽  
1993 ◽  
Vol 13 (12_suppl) ◽  
pp. 34-38 ◽  
Author(s):  
Kathleen Ries Merikangas ◽  
Allen Frances
Keyword(s):  
Psychiatric Disorders ◽  
Diagnostic Criteria ◽  
Classification System ◽  
Psychiatric Classification ◽  
Headache Classification ◽  
Future Developments

This paper reviews the development of diagnostic criteria for the psychiatric disorders in order to provide a model for the development of classification of headache. The strengths and weaknesses of the current psychiatric classification system, and procedures that have been instituted to strengthen the next version of the classification are described. The problems that characterized the successive versions of the criteria are highlighted in order to stimulate future developments of diagnostic criteria for headache syndromes. Recommendations for application of these principles to headache classification are presented.

scholarly journals Revised 2004 International Classification of Headache Disorders: New Headache Types

2004 ◽  
Vol 31 (3) ◽  
pp. 304-314 ◽  
Author(s):  
Jonathan P. Gladstone ◽  
David W. Dodick
Keyword(s):  
Treatment Guidelines ◽  
International Headache Society ◽  
Genetic Research ◽  
Primary Headache ◽  
Current Treatment ◽  
International Classification ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders

In 1988, the International Headache Society created a classification system that has become the standard for headache diagnosis and research. The International Classification of Headache Disorders galvanized the headache community and stimulated nosologic, epidemiologic, pathophysiologic, and genetic research. It also facilitated multinational clinical drug trials that have led to the basis of current treatment guidelines. While there have been criticisms, the classification received widespread support by headache societies around the globe. Fifteen years later, the International Headache Society released the revised and expanded International Classification of Headache Disorders second edition. The unprecedented and rapid advances in the field of headache led to the inclusion of many new primary and secondary headache disorders in the revised classification. Using illustrative cases, this review highlights 10 important new headache types that have been added to the second edition. It is important for neurologists to familiarize themselves with the diagnostic criteria for the frequently encountered primary headache disorders and to be able to access the classification (www.i-h-s.org) for the less commonly encountered or diagnostically challenging presentations of headache and facial pain.

Medication Overuse Headache and Applicability of the ICHD-II Diagnostic Criteria: 1-Year Follow-Up Study (CARE I Protocol)

Cephalalgia ◽  
2009 ◽  
Vol 29 (2) ◽  
pp. 233-243 ◽  
Author(s):  
N Ghiotto ◽  
G Sances ◽  
F Galli ◽  
C Tassorelli ◽  
E Guaschino ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Drug Withdrawal ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Clinical Situation ◽  
Objective Criterion ◽  
Drug Overuse ◽  
Diagnostic Criterion

Medication overuse headache (MOH) is a growing problem worldwide and a challenge for clinicians and investigators. This study aims to contribute to the ongoing debate surrounding the classification of MOH. Applying the revised diagnostic criteria for MOH contained in the updated International Classification of Headache Disorders (ICHD-II), we enrolled 140 probable MOH (p-MOH) patients. They were submitted to an in-patient detoxification protocol and re-examined 2, 6 and 12 months later to confirm, or otherwise, the diagnosis of MOH and to observe the evolution of their headache. MOH diagnosis was confirmed 2 months after detoxification in 71% of patients, who reverted to an episodic headache pattern and stopped their drug overuse The overall clinical situation at 2 months closely reflected the 1-year trend. The 2-month period after drug withdrawal should be retained as a diagnostic criterion in the ICHD-II because it is useful not only as a diagnostic parameter, but also as predictor of a good outcome of 1-year drug withdrawal. In addition, the present findings point to the need for a more objective criterion to quantify headache frequency after drug withdrawal.

scholarly journals International Classification of Headache Disorders - ICHD-4. Will medication-overuse headache survive?

2021 ◽  
pp. 72-74
Author(s):  
Mario Fernando Prieto Peres ◽  
Thaiza Agostini Córdoba de Lima ◽  
Marcelo Moraes Valença
Keyword(s):  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Critical Analysis ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
International Classification ◽  
Headache Disorders ◽  
Critical View

The article is a critical analysis of the diagnostic criteria for medication-overuse headache. This is an important discussion to improve the criteria in the next update, as well as providing a critical view for neurologists when applying the criteria to their clinical practice.

Headache

2020 ◽  
pp. 5987-6005
Author(s):  
Peter J. Goadsby
Keyword(s):  
International Headache Society ◽  
Primary Headaches ◽  
Secondary Headache ◽  
Formal Definitions ◽  
Life Threatening ◽  
External Causes

Headache is among the most common of human maladies. So much so that it is generally (and often incorrectly) assumed to be understood, especially by doctors. The classification of headache, with formal definitions of different diagnostic entities, by the International Headache Society into (1) primary—occurring in the absence of external causes, and (2) secondary—some of which may have sinister cause, has greatly simplified the description, understanding, and management of this often challenging symptom. It also allows those headaches with serious or life-threatening consequences to be distinguished from other forms. This chapter examines the various types of headache, from primary headaches and migraine, and tension-type to secondary headache and other forms.

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.

Classification of Headaches

Cephalalgia ◽  
2001 ◽  
Vol 21 (7) ◽  
pp. 770-773 ◽  
Author(s):  
H Göbel
Keyword(s):  
Ad Hoc ◽  
International Headache Society ◽  
Research Work ◽  
World Health Organisation ◽  
World Health ◽  
World Federation ◽  
Headache Classification ◽  
The World ◽  
Neurological Research

It was not until 1962 that the Ad-Hoc Committee of the National Institute of Health first published a classification of headache syndromes by brief glossary definitions. The general disadvantage of such glossary definitions is that they require subjective interpretation. Therefore under the chairmanship of Prof. Jes Olesen, Copenhagen, the International Headache Society published in 1988 on the basis of empirical findings a first ever headache classification using operationalized criteria. The headache classification of the International Headache Society was immediately translated into the world’s major languages and was adopted by all national headache societies represented in the International Headache Society, the World Health Organisation and the World Federation of Neurology. The new classification proved so successful and enjoyed such rapid international acceptance that no revision was undertaken until 1999. The second edition, again under the chairmanship of Prof. Jes Olesen, will probably be completed in 2002. The classification produced such a high degree of inspiration and motivation of pathophysiological and epidemiological research work that knowledge in the field of headache has displayed growth unparalleled in any other field of neurological research. This development was made possible by the determined work of the Chairman of the Headache Classification Committee, Prof. Jes Olesen. He succeeded in bringing together international researchers, motivating them and jointly turning the current fund of knowledge into a evidence-based classification. Prof. Jes Olesen thus performed the decisive pioneering work for all those who have to do with headaches–patients, doctors and scientists. The IHS classification is the most frequently cited text and one of the most important milestones in the history of the scientific study of headaches.

Vestibular migraine of childhood and recurrent vertigo of childhood: Diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the bárány society and the international headache society

2020 ◽  
pp. 1-9
Author(s):  
Raymond van de Berg ◽  
Josine Widdershoven ◽  
Alexandre Bisdorff ◽  
Stefan Evers ◽  
Sylvette Wiener-Vacher ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Past History ◽  
International Headache Society ◽  
Vestibular Migraine ◽  
Future Research ◽  
Vestibular Disorders ◽  
Consensus Document ◽  
Severe Intensity ◽  
Vestibular Symptoms

This paper describes the diagnostic criteria for “Vestibular Migraine of Childhood”, “probable Vestibular Migraine of Childhood” and “Recurrent Vertigo of Childhood” as put forth by the Committee for the Classification of Vestibular Disorders of the Bárány Society (ICVD) and the Migraine Classification subgroup of the International Headache Society. Migraine plays an important role in some subgroups of children with recurrent vertigo. In this classification paper a spectrum of three disorders is described in which the migraine component varies from definite to possibly absent. These three disorders are: Vestibular Migraine of Childhood, probable Vestibular Migraine of Childhood and Recurrent Vertigo of Childhood. The criteria for Vestibular Migraine of Childhood (VMC) include (A) at least five episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, (B) a current or past history of migraine with or without aura, and (C) at least half of episodes are associated with at least one migraine feature. Probable Vestibular Migraine of Childhood (probable VMC) is considered when at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, are accompanied by at least criterion B or C from the VMC criteria. Recurrent Vertigo of Childhood (RVC) is diagnosed in case of at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between 1 minute and 72 hours, and none of the criteria B and C for VMC are applicable. For all disorders, the age of the individual needs to be below 18 years old. It is recommended that future research should particularly focus on RVC, in order to investigate and identify possible subtypes and its links or its absence thereof with migraine.

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

Cephalalgia ◽  
2017 ◽  
Vol 38 (3) ◽  
pp. 561-567 ◽  
Author(s):  
Elena R Lebedeva ◽  
Natalia M Gurary ◽  
Denis V Gilev ◽  
Jes Olesen
Keyword(s):  
Diagnostic Criteria ◽  
Migraine With Aura ◽  
Field Test ◽  
Structured Interview ◽  
International Classification ◽  
Main Body ◽  
Transient Ischemic Attacks ◽  
Headache Disorders ◽  
Better Than

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.

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.

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