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Field testing alternative criteria for chronic migraine.
M E Bigal1, S J Tepper, F D Sheftell
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. mbigal@aecom.yu.edu
Cephalalgia : an International Journal of Headache
|March 25, 2006
Summary
Current chronic migraine (CM) criteria exclude many patients. Revised criteria, requiring 8 migraine days monthly out of 15 headache days, better capture transformed migraine (TM) sufferers.
Area of Science:
- Neurology
- Headache Medicine
Background:
- The International Classification of Headache Disorders (ICHD-2) criteria for chronic migraine (CM) are restrictive, often excluding patients with transformed migraine (TM).
- Existing diagnostic criteria may not accurately reflect the prevalence and characteristics of chronic migraine in patients with transformed migraine, particularly those with medication overuse.
Purpose of the Study:
- To empirically test three recently proposed, more inclusive criteria for diagnosing chronic migraine (CM) and probable chronic migraine with probable medication overuse (CM+).
- To evaluate how these revised criteria perform in identifying patients with transformed migraine (TM), with or without medication overuse.
Main Methods:
- Individuals with transformed migraine (TM), with or without medication overuse, were included, utilizing headache calendars for at least three consecutive months.
- The study assessed the proportion of subjects meeting current ICHD-2 criteria for CM or CM+.
- Three alternative proposals for CM/CM+ criteria were tested: Proposal 1 (≥15 migraine/probable migraine days/month), Proposal 2 (≥15 headache days/month with ≥50% migraine/probable migraine days), and Proposal 3 (≥15 headache days/month with ≥8 migraine/probable migraine days).
Main Results:
- Only 10.2% of TM patients with medication overuse and 5.6% of TM patients without medication overuse met current ICHD-2 criteria for CM+ or CM, respectively.
- Proposal 3, requiring ≥15 headache days/month with ≥8 migraine/probable migraine days, captured the highest proportions of patients: 94.9% for TM without medication overuse and 91% for TM with medication overuse.
- Statistically significant differences favored Proposal 3 over Proposals 1 and 2 in classifying both TM subgroups.
Conclusions:
- The current ICHD-2 criteria for chronic migraine (CM) and probable chronic migraine with probable medication overuse (CM+) are too restrictive for transformed migraine (TM) patients.
- Revised criteria, specifically Proposal 3 (≥15 headache days/month, with ≥8 migraine/probable migraine days), demonstrate superior inclusivity for diagnosing CM/CM+ in TM populations.
- It is recommended to revise CM and CM+ diagnostic criteria to include patients experiencing at least 8 migraine or probable migraine days per month within a total of 15 or more headache days per month.