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In the field of primary headaches, we have a very useful classification tool for the clinical characterization of individual attacks, but we lack a classification tool for the characterization of primary headache patients. Just because the reasons for this lack have been partially overcome by the knowledge that has been gained in the meantime and because clinicians and researchers are increasingly pressed to find new and reliable ways to manage certain primary headache forms, including so-called chronic migraine, we now have an imperative commitment to provide a syndrome classification. [ABSTRACT FROM AUTHOR]

The analysis of case series of new daily persistent headache (NDPH) reported so far in the literature and the clinical evaluation of affected patients seen at headache clinics suggest that the current International Classification of Headache Disorders (ICHD-II) diagnostic criteria for NDPH are not adequate. In particular, in several instances headache features are not consistent with those of tension-type headache, as the ICHD-II expects. Before making a diagnosis of primary NDPH, it is imperative to rule out that it may be due to any underlying systemic disease. Just as importantly, the presence of psychiatric comorbidity and the possible role played by stressful life factors in triggering NDPH onset should also be searched for. Probably, it will only be through some future improvement in the classification of headache attributed to psychiatric disorder (chapter 12 of the ICHD-II) on the one hand, and through a careful psychological evaluation of patients currently diagnosed as NDPH sufferers on the other, that we will finally know whether primary NDPH actually exists. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate how the criteria of the second edition of the International Classification of Headache Disorders (ICHD-II) and the revised criteria fit a sample of patients with chronic daily headache (CDH). One hundred and five patients with CDH in a tertiary headache centre were included. Headache was assessed using a semi-structured interview. Patients were classified according to the ICHD-II and to the new appendix criteria of the ICHD. Using the ICHDII, 91% of patients received a combination of diagnoses and 76% received only a probable diagnosis: 47% had probable chronic migraine (CM) with probable medication overuse headache (MOH), 28% had probable chronic tension-type headache (CTTH) with probable MOH, 20% had CTTH and 3.8% had CM. Using the new appendix criteria, 88.5% of patients required one diagnosis. Seventy-six percent of patients were classified as MOH, 17% had CTTH and 6.7% had CM. The classification of CDH remains controversial. Alternative criteria for CM with and without medication overuse are discussed. [ABSTRACT FROM AUTHOR]

Migraine occurrence is strongly influenced by the hormonal fluctuations of the female reproductive cycle; at least 60% of women affected by migraine relate the periodicity of their attacks to the menstrual cycle. The so-called menstrual migraine, which occurs immediately before, during or at the end of the menstrual flow, has been a largely undefined condition, including some clinical subtypes which are not well defined. In the last edition of the International Classification of Headache Disorders (ICHD-II), menstrual migraine gained new attention in the Appendix, where three clinical patterns were pointed out: pure menstrual migraine without aura; menstrually related migraine without aura and non-menstrual migraine without aura. Menstrual migraine attacks show severe intensity, long duration (lasting even more than 72 h), marked unresponsiveness to pharmacological treatments, and present higher recurrence rate and work-related disability than non-menstrual attacks. The pharmacological treatment of menstrual migraine can require specific cyclic prophylactic approaches (non-steroidal anti-inflammatory drugs, coxibs, magnesium, long half-life triptans or oestrogen supplements in various formulations), but usually the low frequency of attacks suggests a first approach with specific symptomatic drugs. Preference should be given to triptans, due to their specificity in controlling migraine pain and its accompanying symptomatology; among them, in particular for sumatriptan, many specific studies proved a real effectiveness in the management of acute menstrual migraine attack. [ABSTRACT FROM AUTHOR]

The International Classification of Headache Disorders 2nd Edition (ICHD-II), published in 2004, marks an unquestionable progress from the preceding 1988 edition, but the in-depth analysis it offers is not immune from drawbacks and shortcomings. First of all, it is still basically a classification of attacks and not of syndromes. For the migraine group, while the revised classification more accurately characterises migraine with aura, it fails to provide a sufficiently structured description of those forms of migraine without aura that over the years evolve to so-called daily chronic forms. These forms are not adequately recognised as chronic migraine, which ICHD-II includes among the complications of migraine. The inclusion of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) in the cluster headache group is bound to generate some perplexity, while the recognition of new daily persistent headache (NDPH) included in the group of other primary headaches as a separate clinical entity appears somewhat premature. Doubts are also raised by the actual existence of triptan-overuse headache, which ICHD-II includes in Group 8 among medication-overuse headaches. Finally, the addition of headache attributed to psychiatric disorder, which is certainly a good option in perspective, is not yet supported by an adequate systematisation. [ABSTRACT FROM AUTHOR]