1. INTERNATIONAL CLASSIFICATION of HEADACHE DISORDERS 3rd edition beta, ICHD-3beta
Jes Olesen, Danish Headach Center, Dept of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
©International Headache Society 2013

2. Membership 3rd International Headache clasification committee
Jes Olesen, chair
Lars Bendtsen
David Dodick
Anne Ducros
Stefan Evers
Michael First
Peter J Goadsby
Andrew Hershey
Zaza Katsarava
Morris Levin
Julio Pasqual
Michael B Russell
Todd Schwedt
Timothy Steiner (honoary secretary)
Critina Tassorelli
Gisela M Terwindt
Maurice Vincent
Shuu-Jiun Wang
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3. 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;
ICHD-3 in 2016
©International Headache Society 2013

4. 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
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5. 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
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6. 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
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7. Classification The primary headaches The secondary headaches
Cranial neuralgias, other facial pain and other headaches
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8. 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
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9. 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
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10. 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
©International Headache Society 2013

11. 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
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12. 1.2 Migraine with aura 1.2.1 Migraine with typical aura
Typical aura with headache
Typical aura without headache
Migraine with brainstem aura
Hemiplegic migraine
Familial hemiplegic migraine (FHM)
Familial hemiplegic migraine type 1
Familial hemiplegic migraine type 2
Familial hemiplegic migraine type 3
Familial hemiplegic migraine, other loci
Sporadic hemiplegic migraine
Retinal migraine
©International Headache Society 2013

13. 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
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14. 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
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15. 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
©International Headache Society 2013

16. Chronic migraine A. Headache (tension-type-like and/or migraine-like)
on 15 days per month for >3 months2 and fulfilling
criteria B and C
B. 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 aura
C. 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 derivative
D. Not better accounted for by another ICHD-III
diagnosis.
©International Headache Society 2013

17. Important general rule
If a primary headache gets chronic or significantly worse (doubling or more) in relation to a causative disorder, code for both
©International Headache Society 2013

18. 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 C
B. 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 aura
C. 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
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19. A1.3.1 Chronic migraine with pain-free periods
A. Headache fulfilling criteria for 1.3 Chronic migraine
and criterion B below
B. Interrupted by pain-free periods of >3 hours on ≥5
days per month which are not attributed to drug
treatment.
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20. 1.6 Episodic syndromes that may be associated with migraine
Recurrent gastrointestinal disturbance
Cyclical vomiting syndrome
Abdominal migraine
Benign paroxysmal vertigo
Benign paroxysmal torticollis
A Vestibular migraine
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21. 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
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22. 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