New Appendix Criteria Open for a Broader Concept of Chronic Migraine

Abstract

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.

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

“…[4][5][6][7] The National Headache Foundation defined migraine as episodic (<15) or chronic (≥15 days per month for at least 3 months). [8][9][10] Many adults with episodic migraine experience serious lifestyle restrictions [11][12][13] and need preventive medications. 5,14,15 The US Food and Drug Administration (FDA) has approved four drugs for episodic migraine prevention in adults: two beta blockers (propranolol and timolol) and two antiepileptic drugs (topiramate and divalproex sodium).…”

“…21,22 In clinical practice, physicians and patients choose preventive treatments based primarily on FDA approval and drug tolerability. 9,18,19,[23][24][25] Systematic reviews and meta-analyses with consistent and transparent appraisal of study quality and strength of evidence are essential for arriving at evidence-based migraine preventive treatment and policy decisions. 26 Previously published systematic reviews focused on the efficacy of specific drugs rather than comparative effectiveness and tolerability of all pharmacologic options.…”

Outcome of patients with chronic migraine with medication overuse and depression after duloxetine: influence of coexisting obsessive compulsive disorder

“…Inclusion criteria were: diagnosis of MO according to ICDH-2 revised criteria [11]; history of CM, according to ICDH-2 revised criteria [11]; and presence of major depression. All patients were asked to complete Hamilton depression rating scale (HDRS) and migraine disability assessment scale (MIDAS) before discharge.…”

Positive outcome of occlusal freeway space reestablishment in patients with medication overuse due to chronic migraine

“…Patients with a lateral deviation higher than 0.4 mm compared to the mandibular rest position induced by TENS were considered as candidates for orthosis, according to a previous report from our group [6].…”