Abstract
In the field of so-called chronic daily headache, it is not easy for migraine that worsens progressively until it becomes daily or almost daily to find a precise and universally recognized place within the current international headache classification systems. In line with the 2006 revision of the second edition of the International Classification of Headache Disorders (ICHD-2R), the current prevailing opinion is that this headache type should be named chronic migraine (CM) and be characterized by the presence of at least 15 days of headache per month for at least 3 consecutive months, with headache having the same clinical features of migraine without aura for at least 8 of those 15 days. Based on much evidence, though, a CM with the above characteristics appears to be a heterogeneous entity and the obvious risk is that its definition may be extended to include a variety of different clinical entities. A proposal is advanced to consider CM a subtype of migraine without aura that is characterized by a high frequency of attacks (10–20 days of headache per month for at least 3 months) and is distinct from transformed migraine (TM), which in turn should be included in the classification as a complication of migraine. Therefore, CM should be removed from its current coding position in the ICHD-2 and be replaced by TM, which has more restrictive diagnostic criteria (at least 20 days of headache per month for at least 1 year, with no more than 5 consecutive days free of symptoms; same clinical features of migraine without aura for at least 10 of those 20 days).
Highlights
The 1980s were a seminal period for the study of primary headache, as they were characterized by a wealth of investigational activity and significant progress in the knowledge of the disease, but above all by an increasingly rigorous approach from the scientific point of view.The decade opened with the results of the Danish studies [1, 2] on regional cerebral blood flow in migraine—which was still named ‘‘classic’’ back and is known as ‘‘with aura’’
In line with the 2006 revision of the second edition of the International Classification of Headache Disorders (ICHD-2R), the current prevailing opinion is that this headache type should be named chronic migraine (CM) and be characterized by the presence of at least 15 days of headache per month for at least 3 consecutive months, with headache having the same clinical features of migraine without aura for at least 8 of those 15 days
J Headache Pain (2011) 12:585–592 symptomatic treatment of migraine [3], leading to the introduction of a new class of drugs that are still considered the therapy of choice for migraine attacks
Summary
Gian Camillo Manzoni • Vincenzo Bonavita • Gennaro Bussone • Pietro Cortelli • Maria Carola Narbone • Sabina Cevoli • Domenico D’Amico • Roberto De Simone • Paola Torelli • On behalf of ANIRCEF (Associazione Neurologica Italiana Ricerca Cefalee) Received: 16 August 2011 / Accepted: 5 October 2011 / Published online: 26 October 2011 Ó The Author(s) 2011. This article is published with open access at Springerlink.com
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