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IHS diagnostic criteria

 

In 1988 the International Headache Society published criteria for the diagnosis of a number of different headache types [1]. Those for some of the common headaches are reproduced below for migraine with and without aura, cluster headache, tension-type headache, and cervicogenic headache.


Migraine without aura (MO) diagnostic criteria

A. At least five headache attacks lasting 4 - 72 hours (untreated or unsuccessfully treated), which has at least two of the four following characteristics:

1. Unilateral location

2. Pulsating quality

3. Moderate or severe intensity (inhibits or prohibits daily activities)

4. Aggravated by walking stairs or similar routine physical activity

B. During headache at least one of the two following symptoms occur:

1. Phonophobia and photophobia

2. Nausea and/or vomiting


Migraine with aura (MA) diagnostic criteria

A. At least two attacks fulfilling with at least three of the following:

1. One or more fully reversible aura symptoms indicating focal cerebral cortical and/or brain stem functions

2. At least one aura symptom develops gradually over more than four minutes, or two or more symptoms occur in succession

3. No aura symptom lasts more than 60 minutes; if more than one aura symptom is present, accepted duration is proportionally increased

4. Headache follows aura with free interval of at least 60 minutes (it may also simultaneously begin with the aura

B. At least one of the following aura features establishes a diagnosis of migraine with typical aura:

1. Homonymous visual disturbance

2. Unilateral paresthesias and/or numbness

3. Unilateral weakness

4. Aphasia or unclassifiable speech difficulty


Cluster Headache

A. At least five attacks of severe unilateral orbital, supraorbital and/or temporal pain lasting 15 to 180 minutes untreated, with one or more of the following signs occurring on the same side as the pain

1. Conjunctival injection

2. Lacrimation

3. Nasal congestion

4. Rhinorrhoea

5. Forehead and facial sweating

6. Miosis

7. Ptosis

8. Eyelid oedema

B . Frequency of attacks from one every other day to eight per day


Tension-Type Headache

A. Headache lasting from 30 minutes to seven days

B. At least two of the following criteria:

1. Pressing/tightening (non-pulsatile) quality

2. Mild or moderate intensity (may inhibit, but does not prohibit activity

3. Bilateral location

4. No aggravation by walking, stairs or similar routine physical activity

C . Both of the following:

1. No nausea or vomiting (anorexia may occur)

2. Photophobia and phonophobia are absent, or one but not both are present

 


Cervicogenic Headache

A. Pain localised to the neck and occipital region. May project to forehead, orbital region, temples, vertex or ears

B. Pain is precipitated or aggravated by special neck movements or sustained postures

C . At least one of the following:

1. Resistance to or limitation of passive neck movements

2. Changes in neck muscle contour, texture, tone or response to active and passive stretching and contraction

3. Abnormal tenderness of neck muscles

D. Radiological examination reveals at least one of the following

1. Movement abnormalities in flexion/extension

2. Abnormal posture

3. Fractures, congenital abnormalities, bone tumours, rheumatoid arthritis or other distinct pathology (not spondylosis or osteochondrosis)


Reference:

1 Headache classification committee of the IHS. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988 8: 1-96.