TABLE 18-2. CRITERIA FOR COMMON HEADACHE SYNDROMES

Part of the criteria for all benign headaches is ruling out serious underlying organic disease causing headache (see text).

  1. Migraine without aura. History of at least 5 attacks fulfilling the following criteria (ICHD-3 beta. Cephalgia 2013; 33: 629-808):
    1. Headache attacks lasting 4-72 h (untreated or unsuccessfully treated)
      1. Unilateral (one side) location
      2. Pulsing/pounding quality
      3. Moderate to severe pain intensity
      4. Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs)
    2. During headache at least one of the following:
      1. Nausea
      2. Light and sound sensitivity
    3. Not better accounted for by another ICHD-3 diagnosis
  2. Migraine with aura. History of at least 2 attacks fulfilling the following criteria (ICHD-3 beta. Cephalgia 2013; 33: 629-808):
    1. One of the following fully reversible aura symptoms:
      1. visual (e.g., spots, jagged lines, wavy lines)
      2. somatic sensory (e.g., paresthesia)
      3. speech or language difficulty
      4. motor (e.g., weakness)
      5. brain stem (incoordination, altered consciousness)
    2. 2 of the following 4 characteristics:
      1. 1 aura symptom spreads gradually over ≥5 min, and/or 2 symptoms occur in succession
      2. each individual aura symptom lasts 5-60 min
      3. 1 aura symptom is unilateral
      4. aura accompanied or followed in <60 min by headache
    3. Not better accounted for by another ICHD-3 diagnosis, and TIA excluded
  3. Episodic vs chronic migraine
    1. <15 days per month -Episodic
    2. >15 days per month - Chronic
  4. Cluster headache
    1. Severe unilateral orbital, supraorbital and/or temporal pain
    2. Pain lasts 15-180 minutes
    3. At least one of the following on the side of headache:
      1. Conjunctival injection
      2. Facial sweating
      3. Lacrimation
      4. Miosis
      5. Nasal congestion
      6. Ptosis
      7. Rhinorrhea
      8. Eyelid edema
    4. History of similar headaches in the past
  5. Tension-type headaches
    1. Headache pain accompanied by two of the following characteristics:
      1. Pressing/tightening (nonpulsing) quality
      2. Bilateral location
      3. Not aggravated by routine physical activity
    2. Headache should be lacking:
      1. Nausea or vomiting
      2. Photophobia and phonophobia (one or the other may be present)
    3. Episodic tension-type headache should be present less than 15 days per month and chronic tension-type headache is present more than 15 days per month.
    4. History of similar headaches in the past
  6. Medication Overuse Headache (ICHD-3 beta. Cephalgia 2013; 33: 629-808)
    1. Headache occurring on ≥15 d/mo in a patient with a pre-existing headache disorder
    2. Regular overuse for >3 mo of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
    3. Not better accounted for by another ICHD-3 diagnosis
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