International Headache Society New appendix criteria open for a broader concept of chronic migraine

Department of Neurology, University of Copenhagen, Glostrup Hospital, Demark.
Cephalalgia (Impact Factor: 4.12). 07/2006; 26(6):742-6. DOI: 10.1111/j.1468-2982.2006.01172.x
Source: PubMed

ABSTRACT 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.

Download full-text


Available from: Miguel J A Láinez, Aug 22, 2015
1 Follower
  • Source
    • "According to the frequency of headache in a month, the migraine and TTH patients were classified as episodic (less than 15 headache episodes per month) and chronic (more than 15 headache episodes per month) [20]. Patients with medication overuse headache (MOH) also were selected based on IHS criteria for MOH [21]. Participants were asked to complete the questionnaire in the first day (visit 1), 3rd week (visit 2), and 8th week after the enrollment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. MIDAS is a valid and reliable short questionnaire for assessment of headache related disability. Linguistic validation of Persian MIDAS and assessment of psychometric properties between tension type headache (TTH) and migraine were the aims of this study. Methods. Patients with migraine or TTH were included. At the first visit, we administered a headache symptom questionnaire, MIDAS, and SF-36. Patients filled out MIDAS in second and third visit within three and eight weeks after base line visit. Internal consistency (Cronbach α ) and test-retest reproducibility (Spearman correlation coefficient) were used to assess reliability. Convergent validity and MIDAS capability to differentiate between chronic and episodic headaches (migraine and TTH) were also assessed. Results. The 267 participants had episodic migraine (EM-64%), chronic migraine (CM-13.5%), episodic TTH (ETTH-13.5%), and chronic TTH (CTTH-9). Internal consistency reliability was 0.8 for the entire sample, 0.72 for TTH, and 0.82 for migraine. Test-retest reliability for all questions between visit 1 and visit 2 varied from 0.54 to 0.71. Convergent validity was assessed using SF-36 as an external referent. Patients with episodic headaches (EM and ETTH) had significantly lower MIDAS scores than chronic headaches (CM and CTTH). Conclusion. Persian MIDAS is a valid and reliable questionnaire for migraine and TTH that can differentiate between episodic headache and chronic headache.
    BioMed Research International 01/2014; 2014:978064. DOI:10.1155/2014/978064 · 2.71 Impact Factor
  • Source
    • "OnabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA) is the first headache preventive treatment to receive such approval. Prior to this approval, there have been little controlled data on preventive treatments in CM [17] [19] [20] and very limited evidence-based data available to help physicians care for these patients [4]. A comprehensive Phase III program, the PREEMPT (Phase III REsearch Evaluating Migraine Prophylaxis Therapy) clinical program (PREEMPT 1 and 2), demonstrated that onabotulinumtoxinA treatment is safe, tolerable, and efficacious as long-term (up to 56 weeks) headache prophylaxis in adults with CM [19] [21]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute headache medication overuse (MO) is common in patients with chronic migraine (CM). We evaluated safety and efficacy of onabotulinumtoxinA as preventive treatment of headache in CM patients with baseline MO (CM+MO) in a planned secondary analysis from two similarly designed, randomized, placebo-controlled, parallel, Phase III trials. Patients were randomized to treatment groups (155-195U of onabotulinumtoxinA or placebo) using MO (patient-reported and diary-captured frequency of intake) as a stratifying variable. Of 1384 patients, 65.3% (n=904) met MO criteria (onabotulinumtoxinA: n=445, placebo: n=459). For the CM+MO subgroup at Week 24, statistically significant between-treatment group mean changes from baseline favoring onabotulinumtoxinA versus placebo were observed for headache days (primary endpoint: -8.2 vs. -6.2; p<0.001) and other secondary endpoints: frequencies of migraine days (p<0.001), moderate/severe headache days (p<0.001), cumulative headache hours on headache days (p<0.001), headache episodes (p=0.028), and migraine episodes (p=0.018) and the percentage of patients with severe Headache Impact Test-6 category (p<0.001). At Week 24, change from baseline in frequency of acute headache medication intakes (secondary endpoint) was not statistically significant (p=0.210) between groups, except for triptan intakes (p<0.001), where the onabotulinumtoxinA-treated group was favored. OnabotulinumtoxinA was effective and well tolerated as headache prophylaxis in CM+MO patients.
    Journal of the neurological sciences 06/2013; 331(1-2). DOI:10.1016/j.jns.2013.05.003 · 2.26 Impact Factor
  • Source
    • "Migraine is a common, disabling headache condition that is divided into two forms: episodic migraine (EM) and chronic migraine (CM) [1] [2] [3]. According to population-based studies that generally define CM by the presence of migraine in persons with headaches on at least 15 days per month, CM has a prevalence of 0.91% to 2.2% in adults [4] [5], which is far lower than the EM prevalence of approximately 12% [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To quantify the cost differences and predictors of lost productive time (LPT) in persons with chronic migraine (CM) and episodic migraine (EM). The American Migraine Prevalence and Prevention (AMPP) study is a US national longitudinal survey of severe headache. Cost estimates were obtained via U.S. Census income data. To elucidate the unique predictors of LPT, the optimal distribution for modeling was determined. Zero inflation models for LPT were predicted from sociodemographics, headache features, characteristics and disability, medication use, and depression. The interaction between headache status and age was the primary effect of interest. The eligible sample included 6329 persons with EM and 374 persons with CM. Men with CM aged 45 to 54 years cost employers nearly $200 per week more than do their EM counterparts. Likewise, for women, costs were higher for CM, with the cost differential between EM and CM being $90 per week. After comprehensive adjustment, increases in LPT with age were significantly higher in CM than in EM (rate ratio 1.03; 95% confidence interval 1.01-1.05). When age was recoded to a decade, metric rates of LPT increased 25% more per decade for CM than for EM (rate ratio 1.25; 95% confidence interval 1.004-1.5). LPT is more costly and increases more rapidly for those with CM than for those with EM as age increases.
    Value in Health 02/2013; 16(1):31-8. DOI:10.1016/j.jval.2012.08.2212 · 2.89 Impact Factor
Show more