Choose a patient to see full case study

Emily

Sarah

Marie

39-year-old lawyer with
3 children. The headaches have increased to approximately 18 to 20 per month.
45-year-old headache sufferer with diabetes
and 2 children.
Was prescribed topiramate.
28-year-old hairdresser with IBS who occasionally has hallucinations during her headaches.

What's your diagnosis?

Use the diagnostic criteria below to determine your diagnosis for each of these 3 real patient cases.*
Evolution of a diagnosis
In 2004, the Second International Headache Classification Committee formally introduced the diagnosis of Chronic Migraine.1 Very few patients fit these original diagnostic criteria, so they were revised in 2006.2 These new criteria have since been used in clinical trials.3,4 The formal guidelines can be difficult to implement in clinical practice, and thus simplified classifications have been proposed.5
Did you know?
A majority of Chronic Migraine patients are going underdiagnosed. In a study of 520 Chronic Migraine patients, approximately 80% had not received a diagnosis of Chronic Migraine.6
*Note: These are actual patient case studies. However, names and some details have been changed and photography is of models to protect the anonymity of the patients.

Revised ICHD-2 Diagnostic Criteria for Chronic Migraine (2006)3

  • Headache ≥ 15 days/month for ≥ 3 months with ≥ 5 prior migraine attacks
  • On ≥ 8 days/month headache fulfills the criteria for migraine
  • Not attributed to another causative disorder
  • Without medication overuse headache as defined in Section 8.2 of ICHD-2

Practical Clinical
Criteria for
Chronic Migraine5

  • Headache on
    15 days/month
    AND
  • Current or prior diagnosis of migraine
    AND
  • With or without medication overuse

15 OR MORE

Chronic Migraine is a neurological condition characterized by people who have a history of migraine and experience headaches on 15 or more days per month with headache lasting 4 hours a day or longer.1

Reference:
1.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl 1):9-160.


References:
  1. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl 1):9-160.
  2. Bigal ME, Lipton RB. The differential diagnosis of chronic daily headaches: an algorithm-based approach. J Headache Pain. 2007;8(5):263-272.
  3. Olesen J, Bousser M-G, Diener H-C, et al; Headache Classification Committee. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26(6):742-746.
  4. Dodick DW, Turkel CC, DeGryse RE, et al; PREEMPT Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921-936.
  5. Manack A, Turkel C, Silberstein S. The evolution of chronic migraine: classification and nomenclature. Headache. 2009;49(8):1206-1213.
  6. Bigal ME, Serrano D, Reed M, Lipton RB. Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology. 2008;71(8):559-566.