Editorial: International classification of headache disorders, 3rd Edition, beta version

摘要

The International Classification of Headache Disorders, 3rd Edition, beta version (ICHD-3) was made available in June 2013. In this issue of Headache Currents, Dr. Morris Levin, Professor of Neurology and Psychiatry at the Geisel School of Medicine at Dartmouth in New Hampshire and member of the International Headache Society (IHS) Classification Committee, weighs in with a nuanced, balanced, and detailed description of the ICHD-3, its genesis, and important differences from its predecessor, the ICHD-2. In reviewing the ICHD-3, a number of changes are clear, along with controversies and potential omissions. I will list a few of these: 1. As Dr. Levin points out, once again, aura lasting longer than 1 hour and shorter than 7 days does not have a name. In ICHD-1, this was referred to as prolonged aura, a term greatly missed. 2. As Dr. Levin reminds, once again there is a requirement for imaging changes to meet diagnostic criteria for migrainous infarction. What about patients with objective neurologic deficits, such as demonstrable reflex asymmetry from a small, deep infarct, without imaging changes? This omission remains of concern. 3. As Dr. Levin notes, the new term for basilar-type migraine is migraine with brainstem aura, which will take some getting used to. 4. Chronic migraine (CM) remains a primary headache disorder, without medication overuse. It is no longerconsidered a complication of migraine, but stands alone under migraine, a clear improvement. 5. Pediatric migraine equivalents, previously called childhood periodic syndromes that are commonly precursors of migraine in ICHD-2, are now referred to as episodic syndromes that may be associated with migraine, not a great improvement, but a reflection of the fact that some of these do occur in adulthood. 6. Migrainous vertigo, a desperately needed validated diagnosis, only makes it into the appendix as vertiginous migraine, a disappointment.