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: 4.89). 07/2006; 26(6):742-6. DOI: 10.1111/j.1468-2982.2006.01172.x
Source: PubMed


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.

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    • "Two neurological residents experienced in headache diagnostics conducted all interviews and the physical and neurological examinations. All headaches were classified according to the explicit diagnostic criteria of the ICHD-II and the revised criteria for medication-overuse headache [12-14]. Patients with CTTH were included into the study, while those with chronic migraine were excluded. "
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    ABSTRACT: Most knowledge on chronic tension-type headache (CTTH) is based on data from selected clinic populations, while data from the general population is sparse. Since pericranial tenderness is found to be the most prominent finding in CTTH, we wanted to explore the relationship between CTTH and pericranial muscle tenderness in a population-based sample. An age- and gender-stratified random sample of 30,000 persons aged 30-44 years from the general population received a mailed questionnaire. Those with a self-reported chronic headache were interviewed and examined by neurological residents. The questionnaire response rate was 71% and the interview participation rate was 74%. The International Classification of Headache Disorders II was used. Pericranial muscle tenderness was assessed by a total tenderness score (TTS) involving 8 pairs of muscles and tendon insertions. Cross-sectional data from the Danish general population using the same scoring system were used for comparison. The tenderness scores were significantly higher in women than men in all muscle groups. The TTS was significantly higher in those with co-occurrence of migraine compared with those without; 19.3 vs. 16.8, p = 0.02. Those with bilateral CTTH had a significantly higher TTS than those with unilateral CTTH. The TTS decreased significantly with age. People with CTTH had a significantly higher TTS compared to the general population. People with CTTH have increased pericranial tenderness. Elevated tenderness scores are associated with co-occurrence of migraine, bilateral headache and low age. Whether the increased muscle tenderness is primary or secondary to the headache should be addressed by future studies.
    The Journal of Headache and Pain 09/2014; 15(1):58. DOI:10.1186/1129-2377-15-58 · 2.80 Impact Factor
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    • "Medications used for prophylaxis in episodic migraine may also work in chronic migraine, although only topiramate has established evidence [15,16]. However, this and other unlicensed oral agents have limitations due to poor tolerability and/or adverse effects, and a considerable number of patients do not respond [1,17,18]. More invasive and costly options include greater occipital nerve block (invasive) and occipital nerve stimulation (costly) that have their own limitations and disadvantages to patients and the health service [19]. "
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    ABSTRACT: Background Chronic migraine affects 2% of the population. It results in substantial disability and reduced quality of life. Medications used for prophylaxis in episodic migraine may also work in chronic migraine. The efficacy and safety of OnabotulinumtoxinA (BOTOX) in adults with chronic migraine was confirmed in the PREEMPT programme. However, there are few real-life data of its use. Method 254 adults with chronic migraine were injected with OnabotulinumtoxinA BOTOX as per PREEMPT Protocol between July 2010 and May 2013, their headache data were collected using the Hull headache diary and analysed to look for headache, migraine days decrements, crystal clear days increment in the month post treatment, we looked at the 50% responder rate as well. Results Our prospective analysis shows that OnabotulinumtoxinA, significantly, reduced the number of headache and migraine days, and increased the number of headache free days. OnabotulinumtoxinA Botox also improved patients’ quality of life. We believe that these results represent the largest post-marketing cohort of patients treated with OnabotulinumtoxinA in the real-life clinical setting. Conclusion OnabotulinumtoxinA is a valuable addition to current treatment options in patients with chronic migraine. Our results support findings of PREEMPT study in a large cohort of patients, we believe, is representative of the patients seen in an average tertiary headache centre. While it can be used as a first line prophylaxis its cost may restrict its use to more refractory patients who failed three oral preventive treatments.
    The Journal of Headache and Pain 09/2014; 15(1):54. DOI:10.1186/1129-2377-15-54 · 2.80 Impact Factor
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    • "A diagnosis of medication overuse (MO) was based on the new appendix criteria for a broader concept of CM.9 A participant with CDH was diagnosed with MO if he/she reported regularly overusing acute/symptomatic treatment drugs that were defined in either criterion 1 or 2 for more than 3 months (criterion 1: ergotamine, triptans, opioids, or a combination of analgesics, triptans, or analgesic opioids ≥10 days/month for >3 months; criterion 2: simple analgesics or any combination of ergotamine, triptans, or analgesics opioids ≥15 days/month without the overuse of any single class alone). "
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    ABSTRACT: Background and Purpose Chronic daily headache (CDH) is a commonly reported reason for visiting hospital neurology departments, but its prevalence, clinical characteristics, and management have not been well documented in Korea. The objective of this study was to characterize the 1-year prevalence, clinical characteristics, medical consultations, and treatment for CDH in Korea. Methods The Korean Headache Survey (KHS) is a nationwide descriptive survey of 1507 Korean adults aged between 19 and 69 years. The KHS investigated headache characteristics, sociodemographics, and headache-related disability using a structured interview. We used the KHS data for this study. Results The 1-year prevalence of CDH was 1.8% (95% confidence interval, 1.1-2.5%), and 25.7% of the subjects with CDH met the criteria for medication overuse. Two-thirds (66.7%) of CDH subjects were classified as having chronic migraine, and approximately half of the CDH subjects (48.1%) reported that their headaches either substantially or severely affected their quality of life. Less than half (40.7%) of the subjects with CDH reported having consulted a doctor for their headaches and 40.7% had not received treatment for their headaches during the previous year. Conclusions The prevalence of CDH was 1.8% and medication overuse was associated with one-quarter of CDH cases in Korea. Many subjects with CDH do not seek medical consultation and do not receive appropriate treatment for their headaches.
    Journal of Clinical Neurology 07/2014; 10(3):236-43. DOI:10.3988/jcn.2014.10.3.236 · 1.70 Impact Factor
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