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New headache classification
112
Surg Neurol 1989;31:112
New Headache
Classification
Robert B. Daroff, M.D.
Most current headache classifications derive from the Ad Hoc Committee on Classification of Headache (Arch Neurol 1962;6:173-176). Physicians with extensive experience in treating headaches undoubtedly have problems with aspects of the Ad Hoc Committee classification. Those who give frequent lectures on headaches must make modifications in the classification to suit their individual conceptualizations. For myself, the Ad Hoc Committee category of “Headache of Delusional, Conversion, or Hyperchondriacal States” and the separate category “Muscle-Contraction Headache” are unsatisfactory. 1 combine them al1 as “psychounder which there are several subgenie headaches,” types. The Ad Hoc Committee defined “Vascular Headaches of Migraine Type” as, loosely paraphrased, recurrent headaches, usually throbbing, varied in intensity, frequency, and duration; commonly unilateral in onset; often associated with nausea and vomiting and occasionally preceded by, or associated with, sensory motor or mood disturbance. This description of migraine is imprecise and, primarily for teaching purposes, 1 have used diagnostic criteria modeled from multiple sclerosis classifications with the designations “probable” and “defmite.” Countless other physicians undoubtedly have their own personal psychogenic and migraine headache classifications. Such a situation impedes communication among specialists and leads to considerable difficulty in comparing published research studies. To counter these problems and to promote directed research, the International Headache Society began work on a new headache classification over 2 years ago. A Classification Committee, chaired by Dr. Jes Olesen of the University of Copenhagen, had representatives from seven countries. The Committee was supported by 12 subcommittees composed of approximately 100 members. After numerous meetings of the subcommittees and Committee, a session in San Diego on February 20-21, 1988, with a smal1 group from the American Association of the Study of Headache (at which 1 represented the American Academy of Neurology), achieved a penultimate document. The “Classification and Diagnostic
Publisbed
by Elsevier
Science
Publishing
Co., Inc.
Criteria for Headache Disorders, Cranial Neuralgias, and Facial Pain,” by the Headache Classification Committee of the International Headache Society, has been published in Cephalalgia 1988;8(Suppl 7). The World Health Organization used a draft version for the forthcoming International Classification of Diseases (IDC X). Modeled somewhat after the Diagnostic and Statistical Mamal of Mental Disorders (DSM-111), the Classification contains hierarchically constructed and operationally diagnostic criteria for al1 headache disorders. Diagnosis can be made simply at one- or two-digit levels, but when indicated in specialized centers or for research purposes, four-digit-leve1 diagnoses are possible. Anyone first seeing the new classification may be overwhelmed by its complexity and, at least in my case, irritated by the definitions of some of the categories. My irritation was defused by the persuasiveness of the Committee’s arguments during the San Diego meeting, and 1 am confident that the dispassionate practitioner who is not irrevocably wedded to traditional diagnostic biases wil1 see the “logic, ” if not the soundness, underlying the new diagnostic criteria. The Committee anticipates that “field testing” by practitioners and directed systematic research wil1 cause changes to be incorporated in a Revised Classification, probably in 3 years. In fact, the International Headache Society entourages US to report contradictions, confusions, and deficiencies in current classification. We owe an enormous service to the International Headache Society, its Classification Committee, and the numerous members of the subcommittees for their extraordinary efforts. 1 am optimistic that the new classification wil1 lead to substantive advances in the scientific underpinnings of the mechanisms and, thereafter, the therapy of headaches. A single copy of the classification book may be obtained from the publisher for $30.00. Large discounts are available for bulk purchases. The publisher is FADL’s Publishing House, 29 Prinsesse Charlottesgade, 2200 Copenhagen, Denmark.
0090-3019/89
Surg Neurol 1989;31:112
New Headache
Classification
Robert B. Daroff, M.D.
Most current headache classifications derive from the Ad Hoc Committee on Classification of Headache (Arch Neurol 1962;6:173-176). Physicians with extensive experience in treating headaches undoubtedly have problems with aspects of the Ad Hoc Committee classification. Those who give frequent lectures on headaches must make modifications in the classification to suit their individual conceptualizations. For myself, the Ad Hoc Committee category of “Headache of Delusional, Conversion, or Hyperchondriacal States” and the separate category “Muscle-Contraction Headache” are unsatisfactory. 1 combine them al1 as “psychounder which there are several subgenie headaches,” types. The Ad Hoc Committee defined “Vascular Headaches of Migraine Type” as, loosely paraphrased, recurrent headaches, usually throbbing, varied in intensity, frequency, and duration; commonly unilateral in onset; often associated with nausea and vomiting and occasionally preceded by, or associated with, sensory motor or mood disturbance. This description of migraine is imprecise and, primarily for teaching purposes, 1 have used diagnostic criteria modeled from multiple sclerosis classifications with the designations “probable” and “defmite.” Countless other physicians undoubtedly have their own personal psychogenic and migraine headache classifications. Such a situation impedes communication among specialists and leads to considerable difficulty in comparing published research studies. To counter these problems and to promote directed research, the International Headache Society began work on a new headache classification over 2 years ago. A Classification Committee, chaired by Dr. Jes Olesen of the University of Copenhagen, had representatives from seven countries. The Committee was supported by 12 subcommittees composed of approximately 100 members. After numerous meetings of the subcommittees and Committee, a session in San Diego on February 20-21, 1988, with a smal1 group from the American Association of the Study of Headache (at which 1 represented the American Academy of Neurology), achieved a penultimate document. The “Classification and Diagnostic
Publisbed
by Elsevier
Science
Publishing
Co., Inc.
Criteria for Headache Disorders, Cranial Neuralgias, and Facial Pain,” by the Headache Classification Committee of the International Headache Society, has been published in Cephalalgia 1988;8(Suppl 7). The World Health Organization used a draft version for the forthcoming International Classification of Diseases (IDC X). Modeled somewhat after the Diagnostic and Statistical Mamal of Mental Disorders (DSM-111), the Classification contains hierarchically constructed and operationally diagnostic criteria for al1 headache disorders. Diagnosis can be made simply at one- or two-digit levels, but when indicated in specialized centers or for research purposes, four-digit-leve1 diagnoses are possible. Anyone first seeing the new classification may be overwhelmed by its complexity and, at least in my case, irritated by the definitions of some of the categories. My irritation was defused by the persuasiveness of the Committee’s arguments during the San Diego meeting, and 1 am confident that the dispassionate practitioner who is not irrevocably wedded to traditional diagnostic biases wil1 see the “logic, ” if not the soundness, underlying the new diagnostic criteria. The Committee anticipates that “field testing” by practitioners and directed systematic research wil1 cause changes to be incorporated in a Revised Classification, probably in 3 years. In fact, the International Headache Society entourages US to report contradictions, confusions, and deficiencies in current classification. We owe an enormous service to the International Headache Society, its Classification Committee, and the numerous members of the subcommittees for their extraordinary efforts. 1 am optimistic that the new classification wil1 lead to substantive advances in the scientific underpinnings of the mechanisms and, thereafter, the therapy of headaches. A single copy of the classification book may be obtained from the publisher for $30.00. Large discounts are available for bulk purchases. The publisher is FADL’s Publishing House, 29 Prinsesse Charlottesgade, 2200 Copenhagen, Denmark.
0090-3019/89