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

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 ©International Headache Society 2013

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 ©International Headache Society 2013

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 ©International Headache Society 2013

Classification The primary headaches The secondary headaches Cranial neuralgias, other facial pain and other headaches ©International Headache Society 2013

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 ©International Headache Society 2013

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 ©International Headache Society 2013

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

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 ©International Headache Society 2013

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 ©International Headache Society 2013

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 ©International Headache Society 2013

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 ©International Headache Society 2013

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

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

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

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 ©International Headache Society 2013

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. ©International Headache Society 2013

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 ©International Headache Society 2013

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 ©International Headache Society 2013

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