Comprehensive Application of the International Classification of Headache Disorders Third Edition, Beta Version

Abstract

The purpose of this study was to test the feasibility and usefulness of the International Classification of Headache Disorders, third edition, beta version (ICHD-3β), and compare the differences with the International Classification of Headache Disorders, second edition (ICHD-2). Consecutive first-visit patients were recruited from 11 headache clinics in Korea. Headache classification was performed in accordance with ICHD-3β. The characteristics of headaches were analyzed and the feasibility and usefulness of this version was assessed by the proportion of unclassified headache disorders compared with ICHD-2. A total of 1,627 patients were enrolled (mean age, 47.4±14.7 yr; 62.8% female). Classification by ICHD-3β was achieved in 97.8% of headache patients, whereas 90.0% could be classified by ICHD-2. Primary headaches (n=1,429, 87.8%) were classified as follows: 697 migraines, 445 tension-type headaches, 22 cluster headaches, and 265 other primary headache disorders. Secondary headache or painful cranial neuropathies/other facial pains were diagnosed in 163 patients (10.0%). Only 2.2% were not classified by ICHD-3β. The main reasons for missing classifications were insufficient information (1.6%) or absence of suitable classification (0.6%). The diagnoses differed from those using ICHD-2 in 243 patients (14.9%). Among them, 165 patients were newly classified from unclassified with ICHD-2 because of the relaxation of the previous strict criteria or the introduction of a new diagnostic category. ICHD-3β would yield a higher classification rate than its previous version, ICHD-2. ICHD-3β is applicable in clinical practice for first-visit headache patients of a referral hospital.

Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients

“…The details of the HEREIN study have been reported previously. 29,30 The protocol of the HEREIN study including obtaining informed consent and information-use agreement forms were reviewed and approved by the Institutional Review Board (IRB) at each hospital. Each patient gave written informed consent before participating in the study if the need for informed consent had not been waived by the IRB board at a particular hospital.…”

“…The reliability of the ICHD-3β was 0.61, indicating substantial agreement with the HERE-IN study. 30 In the analysis, the investigator selected the most-important headache for each patient. This study enrolled patients who were diagnosed with a primary headache disorder and underwent clinical neuroimaging.…”

“…The details of secondary headache disorders and cranial neuropathy and other facial pains have been reported previously. 30…”

Short-term diagnostic stability of probable headache disorders based on the International Classification of Headache Disorders, 3rd edition beta version, in first-visit patients: a multicenter follow-up study

“…They would be diagnosed with probable TTH under ICHD-3β. In the HEREIN study, probable TTH was the third most common headache subtype after migraine without aura and primary stabbing headache [ 11 ]. Most probable TTH cases (78.9 %) did not satisfy the criteria for number of attacks or total period at baseline, and their diagnostic stability was lower compared with subgroups of other missing criteria.…”

“…This was a substudy of the headache registry using ICHD-3β for the first-visit patients (HEREIN) study using prospectively collected multicenter data obtained from consecutive first-visit headache outpatients in the headache clinics of 11 hospitals in Korea between August 2014 and February 2015 [ 11 – 13 ]. The study design of the HEREIN study was proposed and reviewed at regular educational meeting of the Korean Headache Society after a request regarding the application of ICHD-3β; study members were board-certified neurologists with special interests in the headache field.…”