Chronic headaches: a clinician’s experience of ICHD-3 beta

Abstract

The International Classification of Headache Disorders, 3rd edition (beta version) has significantly improved the categorization of chronic headaches. From a clinical standpoint, however, it still has a few limitations, both general and specific. Among the former is the fact that international headache classifications are aimed less at defining the disease than at characterizing the features of attacks, meaning that their structure is ill suited to dealing with chronic headaches where the patient must be the focus of the discussion. Among the latter is the fact that the diagnostic criteria for chronic migraine do not distinguish between cases differing widely in severity and that the issue of whether medication overuse headache can be considered an autonomous entity is still unsolved. We propose that changes be made in the systematizations of chronic migraine and medication overuse headache to make them more consistent with clinical practice.

Medication-overuse headache: a widely recognized entity amidst ongoing debate

“…Although considered a general rule in the past, it is now well stated in the classification that MOH usually, but not invariably, resolves once the overuse is stopped [ 22 , 23 ]. As with all secondary headache syndromes in ICHD-3, there is no longer a necessary requirement of remission or substantial improvement of the underlying causative disorder for the diagnosis to be made.…”

“…As with all secondary headache syndromes in ICHD-3, there is no longer a necessary requirement of remission or substantial improvement of the underlying causative disorder for the diagnosis to be made. Therefore, when MOH is confirmed by using the medical history of the patient, a two-fold diagnosis is made: the first one entailing the primary headache syndrome that resulted in drug overuse, the second one MOH [ 23 ].…”

“…Furthermore, the current classification uses clinical features that do not touch upon on the underlying neurobiological processes and has rigid elements such as the cut-off of 15 days per month. These elements may need to be revisited when new evidence becomes available in the future [ 23 ].…”

A Comparison of Clinical Features of Youth with and without Rhinitis Signs and Symptoms Who Are Hospitalized for Headache

“…Therefore, not only primary headache such as migraine but all headaches were included. Chronic headaches were defined as headaches longer than 3 months according to the international classification of headache disorders third edition [ 12 ]. Their medical records were reviewed for clinical symptoms, headache severity (numerical rating scale), evidence of AR (nasal signs and symptoms, allergy test (skin prick or inhalant multiple allergen simultaneous test) results), laboratory and imaging data, and medication history.…”

The evolving classifications and epidemiological challenges surrounding chronic migraine and medication overuse headache: a review

“…Torres-Ferrús et al [ 29 ] argue that there is little difference in those patients that have high-frequency episodic migraine (that is up to or equal to 14 days headache per month) and chronic migraine, and that according to the current criteria for chronic migraine, these high-frequency episodic migraine patients could potentially miss out on treatment options that might otherwise provide benefit. In summary, and as highlighted by Manzoni and Torelli [ 30 ], “the diagnostic criteria for chronic migraine fail to distinguish between patients with very different degrees of severity”.…”