Classification of Chronic Daily Headache by International Headache Society Criteria: Limits and New Proposals

Abstract

We conducted a retrospective study of 150 patients with chronic daily headache (CDH) to determine how to categorize their headache according to the classification of the International Headache Society (IHS). All patients were first evaluated at Parma and Pavia Headache Centres (from January 1992 to March 1993) and had had headache for at least 15 days a month during the previous 6 months. Four patients were thereafter excluded due to poor reliability. The 146 patients who met our CDH criteria (92 with and 54 without clear-cut migraine attacks) could be classified into four groups: (i) chronic tension-type headache (CTTH)--27 patients; (ii) coexisting migraine plus CTTH--65 patients; (iii) unclassifiable daily headache--27 patients; and (iv) migraine and an unclassifiable interval headache--27 patients. Seventy-two percent of patients with CDH had migraine as the initial form of their headache. We therefore propose to revise the IHS classification for migraine, taking into account its evolution, and add two subcategories, migraine with interparoxysmal headache and chronic migraine.

Psychosocial aspects of chronic daily headache

“…Second, no patient with chronic daily HA met criteria for "excessive use" in this study. While the criteria used were less restrictive (i.e., required higher levels of medication to qualify as high medicators) than some studies [26,27] with high rates, they were more restrictive (i.e., required lower levels of medication to qualify as a high medicator) than those used in studies [25,26] that reported excessive use in 12-17% of chronic daily HA sufferers.…”

“…Previous research [5,26,27] has indicated that chronic daily HA sufferers tend to use symptomatic medications excessively, typically classifying 50-73% as high medicators. No studies have compared medication use among those with chronic daily HAs and chronic episodic HA sufferers.…”

Chronic daily headache: how to manage it?

“…The natural history of these patients indicates that the majority of them move from a history of migraine into a near daily headache with clinical features closer to tensiontype headache than to migraine attacks [5].…”

“…In this series a specific diagnosis of headache was given by neurologists in 51% of the patients, but only two patients suffered from a possible drug-associated headache. [3,4] Chronic migraine Manzoni et al [5] Chronic tension-type headache Silberstein et al [3] Chronicized migraine Sicuteri et al [6] Hemicrania continua Silberstein et al [3] Migraine with interparoxysmal headache Manzoni et al [5] Mixed headache -(migraine plus tension-type headache) New daily persistent headache Silberstein et al [3] Transformational migraine a -Persistent daily headache Mathew [7] Evolutive migraine Mathew [8] Transformed migraine Mathew [8] a Used by psychologists…”

Cefaléia crônica diária primária: a propósito de 52 casos

“…Muitos deles apresentam migrânea transformada (MT) ou cefaléia diária persistente de início súbito (CDPIS). Por esse motivo, têm sido propostas modificações na atual classificação 2,[4][5][6][7][8] . As formas episódicas da cefaléia do tipo tensional e da migrânea são, em geral, fáceis de diagnosticar e tratar.…”