Patient Education, Symptoms

Chronic Migraine Defined (A Correction)

In All Migraineurs Are Different — So Stop Judging Me!, I wrote “…losing two days a week to migraine does not meet the clinical definition of chronic migraine, which is 15 or more migraine days a month.” Leora delicately pointed out that this is incorrect. Chronic migraine is actually defined as 15 or more headache days a month, eight of which are migraine. That’s my summary at least.

Verbatim, the current criteria for chronic migraine according to the International Headache Society follows. I’ve left out the footnotes; check the link for details.

A)    Headache (tension-type and/or migraine) on ≥15 days per month for at least 3 months*

B)     Occurring in a patient who has had at least five attacks fulfilling criteria for 1.1 Migraine without aura

C)    On ≥8 days per month for at least 3 months headache has fulfilled C1 and/or C2 below, that is, has fulfilled criteria for pain and associated symptoms of migraine without aura

1)     Has at least two of a-d

a)      unilateral location

b)     pulsating quality

c)      moderate or severe pain intensity

d)      aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)

and at least one of a or b

a)      nausea and/or vomiting

b)     photophobia and phonophobia

2)     Treated and relieved by triptan(s) or ergot before the expected development of C1 above

D)    No medication overuse† and not attributed to another causative disorder‡

I’m not sure if my initial statement was outdated or just outright wrong, but it doesn’t really matter. I appreciate readers who are willing to point out my mistakes without calling me an idiot! Thanks, Leora.

6 thoughts on “Chronic Migraine Defined (A Correction)”

  1. I don’t know what this means, but my body heat rises substantially in addition to the above symptoms. I’m 66, so way past menopause. Going to bed with ice packs below my head help a bit, but I do take difmetre plus 1000 mg tachiprina (I’m an American living in Italy) in addition to the ice packs. Have had severe headaches since I was in my teens.

  2. These are International criteria, and thus insurance coverage in the US was not a consideration in the development of the diagnostic guidelines.

    These guidelines are a dynamic document, and are reviewed on a regular basis to be certain that they are consistent with current scientific research as well usual practices of clinicians.

    Before adoption, sometimes preliminary criteria are published. For example, there is a definition of chronic migraine that also requires that the headache lasts at least four hours a day in addition to the other requirements. This is used by some insurers.

    I too wish that migraine with aura was more clearly included in the criteria. There are people with chronic migraine who do have attacks with aura in addition to headache days without aura. To me, this is still chronic migraine.

  3. It states “…has fulfilled C1 and/or C2 below” so the triptan/ergots do not have to work if the C1 category is fulfilled. I would not be surprised if the triptan/ergot line has something to do with insurance coverage. If there are Guidelines available, insurance companies won’t cover meds unless those Guidelines are being met.

  4. Parin I think they just say migraine without aura b/c with aura then it’s obvious it’s a migraine.

    Kerrie thanks for posting this! Very helpful for CMA (Chronic Migraine Awareness)!

  5. And I wonder why chronic migraone dx ezcludes migraine with aura? And why 3 months of tention-type HA have anything to do with chronic migraine?

    *sigh* Glad I don’t have to rely on IHS information personally. It’s too scrambled up for my poor brain.

  6. Wonder what the triptan/ergot blurb is there for? Triptans are contraindicated for me and ergots don’t help.

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