ICHD-3 Migraine Classification

Study Notes

Migraine

Migraine without aura: Occurs more than five times in a month, lasting 4-72 hours (2-72 hours in children); characterized by unilateral, pulsating pain that is moderate to severe and worsens with activity.
Accompanying symptoms: Includes nausea or vomiting, photophobia, and phonophobia.
Prodrome phase: Can last up to 2 days before onset, featuring fatigue, difficulty concentrating, neck stiffness, and sensitivity to light and sound, among other symptoms.
Postdrome phase: Symptoms can last up to 48 hours post-migraine, including tiredness and difficulty concentrating.
Migraine with aura: Defined by two or more attacks involving sensory disturbances, such as visual or motor symptoms, meeting specific criteria related to symptom duration and character.
Common aura characteristics: Visual auras are prevalent, reported in up to 90% of cases, typically manifesting as fortification spectra (zigzag patterns).
Sensory auras: Involve paresthesias that gradually move along one side of the body, face, or tongue.
Chronic migraine: Defined as more than 15 headache days per month with at least 8 migraine days for over 3 months.
Status migrainosus: A prolonged attack lasting more than 72 hours, significant debilitating pain and associated symptoms may improve with medication or sleep.
Migrainous infarction: More common in younger women, this complication occurs primarily in the posterior circulation.
Associated conditions: Includes episodic syndromes such as recurrent gastrointestinal disturbances and cyclic vomiting, characterized by predictable attacks.

Episodic Syndromes

Recurrent gastrointestinal disturbance: Defined by more than five episodes of abdominal pain, nausea, or vomiting; can be infrequent, periodic, or chronic.
Cyclic vomiting syndrome: Characterized by more than five attacks, predictable periodicity, with associated nausea/vomiting occurring more than four times an hour, lasting longer than one hour and separated by at least one week between episodes.
Abdominal migraine: Defined by five or more attacks lasting 2-72 hours, with associated symptoms including midline abdominal pain, nausea, and vomiting.
Benign paroxysmal vertigo: More than five sudden onset vertigo attacks that resolve spontaneously within minutes to hours, may include additional symptoms such as nystagmus and ataxia.
Benign paroxysmal torticollis: Recurrent head tilt attacks that spontaneously resolve, often accompanied by pallor and irritability; recurrence may follow monthly patterns.

Tension-Type Headache

Prevalence: Affects 30-78% of the population.
Pathophysiology: Infrequent and frequent episodic tension-type headaches may involve peripheral pain mechanisms, while chronic tension-type headaches are influenced by central pain mechanisms.
Pericranial tenderness: Present in all TTH cases, measured at various muscle sites scoring from 0-3; it is worse during headaches and likely linked to pathophysiology.
Episodic tension-type headache: Defined by more than ten headaches occurring for 30 minutes to 7 days, illustrating variability in duration and frequency.