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The International Classification of Headache Disorders revised criteria for chronic migraine—field testing in a headache specialty clinic.
Cephalalgia 2007; 27(3):230-4C

Abstract

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.

Authors+Show Affiliations

Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Bronx, NY 10461, USA. mbigal@aecom.yu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17263770

Citation

Bigal, M E., et al. "The International Classification of Headache Disorders Revised Criteria for Chronic Migraine—field Testing in a Headache Specialty Clinic." Cephalalgia : an International Journal of Headache, vol. 27, no. 3, 2007, pp. 230-4.
Bigal ME, Rapoport AM, Sheftell FD, et al. The International Classification of Headache Disorders revised criteria for chronic migraine—field testing in a headache specialty clinic. Cephalalgia. 2007;27(3):230-4.
Bigal, M. E., Rapoport, A. M., Sheftell, F. D., Tepper, S. J., & Lipton, R. B. (2007). The International Classification of Headache Disorders revised criteria for chronic migraine—field testing in a headache specialty clinic. Cephalalgia : an International Journal of Headache, 27(3), pp. 230-4.
Bigal ME, et al. The International Classification of Headache Disorders Revised Criteria for Chronic Migraine—field Testing in a Headache Specialty Clinic. Cephalalgia. 2007;27(3):230-4. PubMed PMID: 17263770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The International Classification of Headache Disorders revised criteria for chronic migraine—field testing in a headache specialty clinic. AU - Bigal,M E, AU - Rapoport,A M, AU - Sheftell,F D, AU - Tepper,S J, AU - Lipton,R B, PY - 2007/2/1/pubmed PY - 2012/5/15/medline PY - 2007/2/1/entrez SP - 230 EP - 4 JF - Cephalalgia : an international journal of headache JO - Cephalalgia VL - 27 IS - 3 N2 - 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. SN - 0333-1024 UR - https://www.unboundmedicine.com/medline/citation/17263770/The_International_Classification_of_Headache_Disorders_revised_criteria_for_chronic_migraine—field_testing_in_a_headache_specialty_clinic_ DB - PRIME DP - Unbound Medicine ER -