Chronic migraine: Diagnosis based on time course
When the International Headache Society published the first edition of the International Headache Classification (ICHD-I) in 1988, there was no mention of chronic migraine . Migraine was classified as an episodic type of headache . A subtype of migraine that occurs daily or almost daily has not been defined. In contrast, the ICHD-I already headache associated with chronic substance use . The diagnostic criteria for such a drug-induced headache required headaches on at least 15 days per month with daily substance intake in a certain minimum dose for more than three months and remission of the headache within one month after substance withdrawal. The diagnosis could only be made if the appropriate substance withdrawal was successfully carried out. Finally, the ICHD-I chronic tension-type headache . The ICHD-I classification principle envisaged multiple diagnoses with differentiation of different headache disorders, which should be the basis for targeted treatment. A typical patient at a headache specialist consultation with daily headaches received the three diagnoses of a migraine, a chronic tension-type headache and, before drug withdrawal treatment was carried out, the suspected diagnosis of a headache due to chronic substance use.
A sub-differentiation into chronic migraine with at least 15 migraine days per month, which cannot be explained by another disorder or medication overuse, occurred in 2004 in the 2nd edition, ICHD-II. At the same time, the concept of chronic daily headache or transformed migraine was spread in the USA. The latter diagnosis described the transition from an episodic to a chronic form of migraine - regardless of the presence of medication overuse. There is still no globally accepted agreement on a uniform diagnosis of chronic migraines or headaches caused by medication overuse. An overview of the ongoing development of the definitions, classification and diagnostics of these clinical pictures over the last decade can be found here:
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