From Hemicrania Lunaris to Hemicrania Continua: An Overview of the Revised International Classification of Headache Disorders

Abstract

The International Headache Society's (IHS) Classification of Headache Disorders, published in 1988, is largely responsible for stimulating the rapid scientific and therapeutic advances that have revolutionized the field of headache. By establishing consistent operational diagnostic criteria for primary and secondary headache disorders, the IHS Classification has facilitated epidemiological and genetic studies as well as the multinational clinical trials that provide the basis for our present treatment guidelines. Fifteen years after its original release, a revised 2nd edition has been unveiled. Modifications are small but significant. We hope to introduce clinicians to the salient changes in the 2nd edition by highlighting the newly included headache types, acknowledging the renamed headache types, and reviewing the modifications in diagnostic criteria for existing headache types. Physicians involved in the care of headache patients need to be aware of these changes and should continue to consult the IHS criteria to ensure accurate diagnosis, to continue to refine the diagnostic criteria, and to contribute to the body of knowledge necessary to make further advances in the classification as well as in the field of headache.

Validation of the Classification of Migraine Without Aura (IHS A1.1) Proposed in ICHD‐2

“…Each classification modification has improved communication, stimulated further research, and provided healthy debate while advancing the field of headache 4–29 . Migraine, as the prototype of the primary headache with no known cause, continues to be the subject of intense research.…”

The International Classification of Headache Disorders, 3rd Edition (ICHD III) – Changes and Challenges

“…Migraine descriptions date from ancient Egypt, but the first clear headache classification is seen in the writings of Aretaeus of Cappadocia, in the 1st century AD, who divided headaches into cephalea (chronic, frequent, severe, long‐lasting headaches) and cephalalgia (infrequent milder headaches). In his “De Cephalalgia” (1672), Thomas Willis divided headaches into the following categories: (1) within or without the skull; (2) universal or particular; (3) short, continuous, or intermittent; (4) wandering or uncertain; (5) before, behind, or the side; and (6) occasional or habitual . The first significant modern attempt at classifying headache disorders was done by an ad hoc committee formed by the US National Institutes of Health in 1962, which consisted of a number of prestigious thinkers in headache: Arnold Friedman, Knox Finley, John Graham, Charles Kunkle, Adrian Ostfeld, and Harold Wolff .…”

Introductory Remarks on Metastatistics for the Practically Minded Non-Bayesian Regression Runner

“…It has been conceded that Fisher was correct. (Bahra et al, 2003, Lance et al, 1988 54 For a brief history of the ICHD, see Gladstone and Dodick (2004). 55 Boes and Capobianco (2005) and Ferrari et al (2007) describe some of the tangled history as well.…”