Abstract
BackgroundChronic headache (CrH) occurs commonly in the population, and chronic migraine (CM) accounts for much of the CrH. Diagnostic criteria for CM remain controversial, and this could lead to undertreatment of CM. The purpose of this study was to analyze the clinical profiles of CM and to field test the International Classification of Headache Disorders-3β criteria (ICHD-3β) and Expert Opinion criteria (EO) for CM application.MethodsWe retrospectively reviewed the medical records of CrH patients in our headache clinic during the period. Eligible patients were selected from CrH population based on Silberstein and Lipton criteria (S-L) for CM, and meanwhile fulfilled with migraine days at least 8 days/month. Then we evaluated the characteristics of clinic profiles and outcomes between patients diagnosed CM using ICHD-3β and EO criteria. Field tested the CM criteria Of ICHD-3β and EO.ResultsIn a total of 710 CrH patients , 261 (36.8 %) were recruited with CM based on both S-L criteria and fulfilled at least 8 migraine days/month. Be understandable, all the 261 patients met the EO criteria, and only 185 (70.9 %) met ICHD-3β for CM. For the 76 patients who met EO but not ICHD-3β, 70 had atypical migraine attacks (probable migraine, PM), and another 6 had typical migraine attacks but less than a total history of 5 attacks. Although 173 (66.3 %) were concurrent with medication overuse, just one patient overused triptans and none used ergot agents. Clinical features were not significantly different between the ICHD-3β and EO criteria groups (P > 0.05), and neither were outcomes of prophylaxis (P = 0.966). Total migraine prophylaxis effectiveness was 73 %.ConclusionMigraine-specific analgesics are rarely used in China, permitting patients with PM to avail themselves of “migraine days” is a reasonable accommodation for this difficult condition. In our hands, use of the new EO criteria for diagnosis of CM increases the sensitivity and maintains the specificity of decision making, and therefore should be adopted in CM management practice.
Highlights
Chronic headache (CrH) occurs commonly in the population, and chronic migraine (CM) accounts for much of the CrH
Of the 173 CM patients with documented medication overuse, 123 (71.1 %) patients fulfilled CM and medication overuse headache (MOH) based on International Classification of Headache Disorders-3β criteria (ICHD-3β), other 50 patients were diagnosed with probable migraine (PM)
Of the CrH patients, 26.1 % (185/710) patients fulfilled ICHD-3β criteria for CM, but 36.8 % (261/710) patients were diagnosed CM based on Expert Opinion criteria (EO), and the benefit outcomes who received migraine prophylaxis were identical between the two groups
Summary
Chronic headache (CrH) occurs commonly in the population, and chronic migraine (CM) accounts for much of the CrH. Chronic headache (CrH) refers to a group of headache disorders occurring at least 15 days/month exceeding 3 months, including those associated with medication overuse [1, 2]. The most common form of CrH in patients presenting to Transformed migraine ( called chronic migraine, CM) was first proposed by Silberstein and Lipton (S-L) in 1994 [6]. It was classified as CM with or without medication overuse (CM+ and CM-, respectively) [6]. CM criteria were standardized in the Second Edition of the International Classification of Headache Disorders (ICHD-2) in 2004, which required migraine symptoms to be present at least 15 days/month and excluded medication overuse headache (MOH) [7]. Revised criteria (ICHD-2R) published in 2006 modified this, requiring
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