Editor’s note: The Headache Classification Committee of the International Headache Society first developed the classification and diagnostic criteria for headache disorders in 1988, and in January 2004, after 15 years of use of the first edition of the International Classification of Headache Disorders, the International Headache Classification Committee released the second edition of the International Classification of Headache Disorders, which was revised over a period of 3.5 years; WH0 proposed that migraine, along with tetraplegia, mental disorders and dementia Migraine has become one of the most serious chronic dysfunctional diseases. The prevalence of migraine in Europe and the United States is 1500-2000/100,000 people, with an incidence rate of 10%-15%; in China, the prevalence is 732.1/100,000 people, with an incidence rate of 0.06%. The low prevalence of migraine in China has a lot to do with the fact that some hospitals, especially primary hospitals, often have “neurovascular headache” and “neurogenic headache” in their medical records, which do not exist in the international headache classification standards. In order to bring the diagnosis and treatment of headache in China in line with the international standard, to make the domestic scientific research results recognized by the foreign counterparts, and to let the medical personnel understand the new International Classification of Headache Disorders, this journal publishes the main parts of it as follows.
I. The Classification of Headache is divided into three major parts and 14 categories.
The first part is primary headache: migraine, tension-type headache, cluster headache, primary trigeminal neuralgia, and other primary headaches.
The second part is secondary headache: headache attributable to head and/or neck trauma, headache attributable to cranial or cervical vascular disease, headache attributable to non-vascular intracranial disease, headache attributable to certain substances or withdrawal from certain substances, headache attributable to infection, headache attributable to metabolic disease, headache attributable to diseases of the head, neck, eyes, ears, nose, sinuses, teeth, mouth or other head and facial structures, headache attributable to psychiatric disorders, and headache attributable to other diseases. headache, and headache attributed to mental disorders.
The third part is cranial nerve, central and primary facial pain and other headaches: there are cranial nerve pain and facial pain related to central diseases, other types of headache, cranial nerve pain, central or primary facial pain.
In the category of migraine, two new subtypes of migraine with aura are added: “headache without typical migraine aura” and “disseminated hemiplegic migraine”.
III. Oculomotor paralysis type migraine
It is included in cranial neuralgia and facial pain related to central diseases. The diagnostic criteria are
1. At least 2 episodes satisfy B.
2. Migraine-like headache attacks occur simultaneously or within 4 days with mild paralysis of one or more of the 3rd, 4th and/or 6th cerebral nerves.
3.Appropriate examination of the headache should be carried out to ensure that the headache is not a cause of the headache.
IV. The diagnostic criteria for aura migraine are changed to
1. At least 2 attacks conform to B.
2. Migraine aura meets one of all the aura of the 6 derived forms.
3. Not attributable to other disorders.
V. The absence of movement disorders was emphasized in the diagnostic criteria for headache with typical migraine aura.
1.At least 2 occurrences meet criteria B to D.
2. The aura includes at least one of the following, but no movement disorder.
① Fully recoverable visual symptoms, including positive symptoms (e.g., punctate chromatophores or linear flash hallucinations) and/or negative symptoms (e.g., visual field deficits).
(ii) Fully recoverable sensory symptoms, including positive symptoms such as pins and needles and/or negative symptoms, such as numbness.
③ Fully recoverable speech difficulty.
3. At least 2 of the following are met.
①Bilateral visual symptoms and/or unilateral sensory symptoms.
②at least one aura symptom gradually progressing for ≥5min and/or different aura symptoms appearing one after another for ≥5min.
③Each symptom ≥5min and ≤60min.
4. Headache meeting criteria B to D for migraine without aura occurred during the aura period or within the next 60 min of the aura symptoms.
5. Not attributable to other disorders.
Sporadic hemiplegic migraine is a new addition to the subtype of “migraine with aura”, and its diagnostic criteria are
1. At least two attacks meet criteria B to C.
2. The aura should include at least one of the following, in addition to fully recoverable weakness in mobility.
① fully recoverable visual symptoms, including positive symptoms (such as punctate chromatophores or linear flash hallucinations) and/or negative symptoms (such as visual field deficits).
(ii) Fully recoverable sensory symptoms, including positive symptoms (such as pins and needles) and/or negative symptoms (such as numbness).
③Fully recoverable speech difficulty.
3. At least 2 of the following are met.
①at least one aura symptom gradually developed for ≥5min and/or different aura symptoms appeared one after another for ≥5min. ②each symptom was ≥5min and ≤24h.
③A headache that meets criteria B to D for migraine without aura occurs during the aura period or within the next 60 min of having aura symptoms.
4. An attack meeting criteria A to E without first or second degree correlation.
5. Not attributed to other diseases.
Periodic vomiting is a new subtype of “childhood periodic syndrome that may be a precursor to migraine”, which is usually seen in children under 2 years old. The diagnostic criteria are
1. At least 5 episodes meeting criteria B and C.
2. Periodic episodes of intense nausea and vomiting lasting from 1h to 5 days in individual children with stereotyped episodes.
3, Vomiting at least 4 times/h or at least 1h during the attack.
4. Complete resolution of symptoms between 2 episodes.
5.No attribution to other diseases.
VIII. Abdominal migraine is also a new subtype of “childhood cyclic syndrome with possible migraine precursors”, and the diagnostic criteria are
1. At least 5 attacks meet criteria B to D.
2. Abdominal pain episodes lasting 1 to 72 h (untreated or unsuccessfully treated).
3. The abdominal pain has all of the following characteristics.
①Located in the midline, around the umbilicus or difficult to locate.
②The nature of the pain is dull or “slight pain”.
③The degree is moderate or severe.
4. At least 2 of the following during abdominal pain
①Loss of appetite.
② nausea.
③Vomiting.
④pallor.
5.Can’t be attributed to another disease.
The diagnostic criteria for benign paroxysmal vertigo in children should be “multiple episodes of severe vertigo without aura, relieving on its own after a few minutes to a few hours” at least 5 times. The interictal neurological examination, hearing and vestibular function should be normal, and the EEG should be normal.
X. No infarct persistent aura, which is difficult to distinguish from transient ischemic attack (TIA). The diagnosis can be considered when one or more aura symptoms of the current attack persist for more than 1 week in patients with aura migraine and are the same as those of previous typical attacks. In clinical practice, TIA should be considered first if it is difficult to distinguish, so as not to delay rescue treatment.
XI. Episodic episodic tension-type headache is a subtype of tension-type headache, which is more common in clinical practice. The difference of its diagnostic criteria is that the duration and number of attacks are limited.
1.The average number of attacks is less than 1 day per month, but at least 10 attacks per year (less than 12 days per year), and the diagnostic criteria B~D are met.
2.Headache lasting from 30 minutes to 7 days.
3.Headache with at least 2 of the following characteristics.
① Bilateral headache.
(ii) Compressive or tightness-like in nature (non-pulsating).
(iii) Mild to moderate headache.
④Daily activities such as walking or going up stairs do not aggravate the headache.
4.Meet the following two items.
① absence of nausea and vomiting (may be anorexia).
②No more than one of photophobia or phonophobia.
5.It cannot be attributed to other diseases.
XII. Frequent paroxysmal tension-type headache is the same as “episodic tension-type headache” except that “the average monthly attack is greater than 1 day and less than 15 days, but at least 10 attacks (≥12 times per year and <180 days) for at least 3 months". B to D of the diagnostic criteria.
XIII. The classical diagnosis of trigeminal neuralgia emphasizes the importance of pain characteristics, and the diagnostic criteria are
1. The disease has a sudden onset, lasts 1 to 3 seconds, affects one or more branches of the trigeminal nerve, and satisfies criteria B and C.
2. The pain has at least one of the following characteristics.
① Intense, sharp, superficial or stabbing.
(2) It is in the trigger area or induced by a trigger factor.
3, The attack is stereotyped for the individual patient.
4. There is no clinical evidence of a neurological deficit.
5. There is no other etiology.