©International Headache Society 2013 INTERNATIONAL CLASSIFICATION of HEADACHE DISORDERS 3rd edition beta, ICHD-3beta Jes Olesen, Danish Headach Center,

©International Headache Society 2013

INTERNATIONAL CLASSIFICATIONof

HEADACHE DISORDERS

3rd edition beta, ICHD-3beta

Jes Olesen, Danish Headach Center, Dept of Neurology, Glostrup Hospital, University of Copenhagen, Denmark

Membership 3rd International Headache clasification committee

• Julio Pasqual• Michael B Russell• Todd Schwedt• Timothy Steiner

(honoary secretary)

• Critina Tassorelli• Gisela M Terwindt• Maurice Vincent• Shuu-Jiun Wang


• Jes Olesen, chair• Lars Bendtsen• David Dodick• Anne Ducros• Stefan Evers• Michael First• Peter J Goadsby• Andrew Hershey• Zaza Katsarava• Morris Levin


History

• ICHD-1 1988 and ICHD-2 in 2004• Headache Classification Committee of

the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia 2013;33 629-808

• ICHD-3 in 2016

Why a beta version?

• WHO wants field testing of ICD-11

• ICHD-3 should also be field tested

• An opportunity for broad input and detection of errors

• Research opportunities• Allows final version to bring final

WHO codes©International Headache Society 2013

Relation to WHO`s International Classification of Diseases

11th edition (ICD-11)• ICD-11 immensely important for

medical statistics and reimbursement

• Developed a bit after ICHD-3 but otherwise in parallel

• Headache in ICD-11 greatly has its own block

• All important headache diagnoses now under neurology©International Headache Society 2013

Use ICHD-3beta immediately

• Dont continue with ICHD-2• Final ICHD-3 will not differ

much• Translate the beta version for

immediate use• Remember to cite ICHD-3.

More relevant and benefits Cephalalgia


Classification


• The primary headaches• The secondary headaches• Cranial neuralgias, other facial

pain and other headaches


Structure

One chapter (1-13) per major group:• introduction• headache types, subtypes, subforms with:

– previously used terms– disorders that are related but coded

elsewhere– short descriptions– explicit diagnostic criteria– notes and comments

• selected bibliography


Appendix for:

• research criteria for novel entities that have not been sufficiently validated

• alternative diagnostic criteria that may be preferable but for which the evidence is insufficient

• a first step in eliminating disorders included in previous editions but for which insufficient evidence


Important general rule

1. Each distinct type of headache that a patient has must be separately diagnosed and coded

– eg, a severely affected patient may receive three diagnoses and codes:1.1 Migraine without aura,2.2 Frequent episodic tension-type headache and 8.2 Medication-overuse headache

Migraine classification

• 1.1 Migraine without aura• 1.2 Migraine with aura• 1.3 Chronic migraine• 1.4 Complications of migraine• 1.5 Probable migraine• 1.6 Episodic syndromes that may be

associated with migraine


1.2 Migraine with aura


• 1.2.1 Migraine with typical aura• 1.2.1.1 Typical aura with headache• 1.2.1.2 Typical aura without headache• 1.2.2 Migraine with brainstem aura• 1.2.3 Hemiplegic migraine• 1.2.3.1 Familial hemiplegic migraine (FHM)• 1.2.3.1.1 Familial hemiplegic migraine type 1• 1.2.3.1.2 Familial hemiplegic migraine type 2• 1.2.3.1.3 Familial hemiplegic migraine type 3• 1.2.3.1.4 Familial hemiplegic migraine, other loci• 1.2.3.2 Sporadic hemiplegic migraine• 1.2.4 Retinal migraine

Migraine with aura

• A. At least two attacks fulfilling criteria B and C• B. One or more of the following fully reversible aura symptoms: 1. visual 2. sensory 3. speech and/or language 4. motor 5. brainstem 6. retinal• C. At least two of the following four characteristics: 1. at least one aura symptom spreads gradually over 5 minutes, and/or two or more symptoms occur in succession 2. each individual aura symptom lasts 5-60 minutes1 3. at least one aura symptom is unilateral2 4. the aura is accompanied, or followed within 60 minutes, by headache


Migraine with typical aura• A. At least two attacks fulfilling criteria for 1.2• B. Aura consisting of visual, sensory and/or

speech/ language symptoms, each fully reversible,

but no motor, brainstem or retinal symptoms


Migraine with typical aura appendix


C. At least three of the following six characteristics: 1. at least one aura symptom spreads gradually over 5 minutes 2. two or more aura symptoms occur in succession 3. each individual aura symptom lasts 5–60 minutes 4. at least one aura symptom is unilateral 5. at least one aura symptom is positive 6. the aura is accompanied, or followed within 60 minutes, by headache

Chronic migraine


A. Headache (tension-type-like and/or migraine-like) on 15 days per month for >3 months2 and fulfilling criteria B and CB. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with auraC. On 8 days per month for >3 months, fulfilling any of the following : 1. criteria C and D for 1.1 Migraine without aura 2. criteria B and C for 1.2 Migraine with aura 3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivativeD. Not better accounted for by another ICHD-III diagnosis.

• If a primary headache gets chronic or significantly worse (doubling or more) in relation to a causative disorder, code for both


Important general rule

Chronic migraine appendix


A. Headache (tension-type-like and/or migraine-like) on 15 days per month for >3 months and fulfilling criteria B and CB. Occurring in a patient who has had at least five attacks fulfilling criteria B–D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with auraC. On 8 days per month for >3 months fulfilling any of the following: 1. criteria C and D for 1.1 Migraine without aura 2. criteria B and C for 1.2 Migraine with aura 3. criteria A and B for 1.5 Probable migraine

A1.3.1 Chronic migraine with pain-free periods


A. Headache fulfilling criteria for 1.3 Chronic migraine and criterion B belowB. Interrupted by pain-free periods of >3 hours on ≥5 days per month which are not attributed to drug treatment.

1.6 Episodic syndromes that may be associated with migraine

• 1.6.1 Recurrent gastrointestinal disturbance

• 1.6.1.1 Cyclical vomiting syndrome• 1.6.1.2 Abdominal migraine• 1.6.2 Benign paroxysmal vertigo• 1.6.3 Benign paroxysmal

torticollis• A 1.6.6 Vestibular migraine


A1.6.5 Vestibular migraine• A. At least five episodes fulfilling criteria C and D• B. A current or past history of 1.1 Migraine without aura or 1.2 Migraine with aura1• C. Vestibular symptoms of moderate or severe intensity, lasting between 5 minutes and 72 hours• D. At least 50% of episodes are associated with at least one of the following three migrainous features: 1. headache with at least two of the following four:

a)unilateral location b) pulsating quality c) moderate or severe intensity d) aggravation by routine physical activity

2. photophobia and phonophobia 3. visual aura


Conclusions

• ICHD-3 beta is published, use it immediately

• Translate it• Find mistakes and report to

relevant chapter chairperson• Participate in Field testing


©International Headache Society 2013 INTERNATIONAL CLASSIFICATION of HEADACHE DISORDERS 3rd edition beta, ICHD-3beta Jes Olesen, Danish Headach Center,

Documents

aura international headache

important headache

parallel headache

distinct type of headache

introduction headache

migraine classification

denmark slide

final ichd