Adoption of Revised Criteria for Chronic Migraine Urged

[Admin]

NEW YORK (Reuters Health) Apr 18 - Revised criteria for chronic migraine recently proposed by the Headache Classification Committee of the International Headache Society perform better than older criteria and should be adopted, according to a report in the March Cephalalgia.

The proposed International Classification of Headache Disorders criteria (ICHD-2R) classify individuals as having chronic migraine if they have at least five previous migraine attacks, and who currently have at least 15 days of headache and at least 8 days of migraine and/or headaches that respond to specific acute migraine medications, the authors explain.

The existing criteria (ICHD-2) classify chronic migraine as a complication of migraine in those cases where the headaches fulfill criteria for migraine in more than 15 days a month and medication overuse is not present.

Dr. Marcelo E. Bigal from Albert Einstein College of Medicine, Bronx, New York and colleagues conducted a field-test study of 557 patients with transformed migraine to assess ICHD-2R criteria for chronic migraine.

Of 158 patients with transformed migraine without overuse, only 9 (5.6%) met the ICHD-2 criteria for chronic migraine, the authors report, whereas 146 (92.4%) met ICHD-2R criteria for chronic migraine.

Similarly, 41 (10.2%) of 399 individuals who had at least 8 days of migraine per month could be classified as chronic migraine with medication overuse according to ICHD-2, the researchers note, compared with 348 (86.9%) who could be classified with medication overuse headache and probable chronic migraine according to ICHD-2R.

The ICHD-2R criteria also performed better than other proposed criteria in diagnosing chronic migraine with or without medication overuse, the report indicates.

"The ICHD-2R represents an important improvement in the definition of chronic migraine, although it is still not possible to say if it maps onto disease biology," the investigators conclude. "It clearly addresses most of the criticism towards the ICHD-2 and should be adopted in clinical practice and research."

"Further discussion should consider whether chronic migraine should be divided into with and without medication," the researchers add.

Cephalalgia 2007;27:230-234.

Source: http://www.medscape.com/viewarticle/555395?src=mp