[The International Headache Society (IHS) has established the following diagnostic criteria.
I. Migraine without aura
Previously known as: common migraine, simple migraine.
Description: Spontaneous recurrent headache attacks lasting from 4 to 72 hours. The typical feature of the headache is a throbbing headache confined to one side, moderate or severe in degree, which may be aggravated by daily somatic activities, with nausea, fear of sound and photophobia.
Diagnostic criteria.
1.At least 5 attacks meet the criteria of b – d.
2.The duration of the headache attack is 4–72 hours (if untreated or treatment is ineffective).
3.Headache with at least two of the following characteristics.
(1) Confined to one side.
(2) Pulsating in nature.
(3) Moderate or severe in degree (restriction or cessation of daily activities).
(4) Aggravated by stair climbing or other similar daily physical activities.
4. The headache period has at least one of the following.
(1) Nausea and/or vomiting.
(2) Photophobia and phonophobia.
5. At least one of the following.
(1) History, physical examination and neurological examination not suggestive of symptomatic headache.
(2) History and/or physical and/or neurologic examination suggestive of symptomatic headache, but can be ruled out by appropriate tests.
(3) Symptomatic headache is present, but the first migraine attack is not clearly related in time to the symptomatic headache.
II. Migraine with aura
Description: Spontaneous recurrent headache presenting with neurologic symptoms that can be clearly identified as being located in the cerebral cortex or brainstem, usually occurring gradually over 5 – 20 minutes and usually lasting less than 60 minutes. Headache, nausea, and/or photophobia follow neurological aura symptoms and may be followed by the following 1-hour asymptomatic intervals. The headache often lasts 4–72 hours, but may be absent altogether.
Previously known as: classic migraine, classic migraine, complex migraine.
Diagnostic criteria.
1. At least two episodes matching b.
2. Having at least 3 of the following 4 features.
(1) 1 or more fully reversible aura symptoms manifesting as focal cortical and/or brainstem dysfunction.
(2) Gradual onset of at least 1 aura symptom lasting more than 4 minutes, or 2 or more aura symptoms occurring consecutively.
(3) The duration of the aura symptoms does not exceed 60 minutes, and if there is more than 1 aura symptom, the duration of the symptoms increases accordingly.
(4) The headache occurs after the aura with an interval of less than 60 minutes (the headache can occur before or simultaneously with the aura symptoms).
3. Have at least one of the following.
(See item e for migraine without aura)
Ocular muscle paralysis type migraine
Retinal-type migraine
Childhood cyclic syndrome: may be migraine aura or related to migraine
Complications of migraine
III. Differential diagnosis
The main two types of headache are distinguished from
Tension headache
Episodic tension headache: recurrent headaches that do not exceed 180 days in a year and last 30 minutes to 7 days each. The nature of the headache is a feeling of pressure or tightness. Mild or moderate. Located on both sides. Not aggravated by daily somatic activities, not accompanied by nausea, but there may be photophobia and phonophobia (only one).
Chronic tension headache: headache that is more than 15 days daily and lasts for at least 6 months. Other features as described above.