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AN OVERVIEW OF INTERNATIONAL CLASSIFICATION OF HEADACHE DISORDERS- ICHDII Dr Prashant Makhija

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Page 1: International classification of headache disorders  changes in ichd2

AN OVERVIEW OF

INTERNATIONAL CLASSIFICATION OF

HEADACHE DISORDERS- ICHDII

Dr Prashant Makhija

Page 2: International classification of headache disorders  changes in ichd2

NEED FOR CLASSIFICATION

Uniformity – minimizing inter & intra observer variation among professionals

Communication

Standardized approach to research

Formulating treatment guidelines

Page 3: International classification of headache disorders  changes in ichd2

HISTORY

First recorded classification system ,Thomas Willis, in De Cephalalgia in 1672

1787, Christian Baur, divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories

Wolff’s Headache. S Silberstein, R B Lipton, David W Dodick. 8th edition

Page 4: International classification of headache disorders  changes in ichd2

1960s, ad hoc committee of the World Federation of Neurology, ad hoc committee of the US National Institutes of Health, merely listed the few headache disorders recognized at that time, gave short descriptions, no diagnostic criteria

First internationally acceptable and clinically useful classification system came in 1988- ICHD I(opinion of experts)

2004, ICHD II, accepted by the WHO , incorporated in the International Classification of Diseases 10 (evidence-based revision) (ICD 10)

ICHD III, expected January 2013

Wolff’s Headache. S Silberstein, R B Lipton, David W Dodick. 8th edition

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ICHD II

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OPERATIONAL RULES

Classification is hierarchical- 4 digits for coding, diagnoses with varying degrees of specificity

1st digit- major diagnostic category

2nd digit- subtype within that diagnostic category

Subsequent digits- more specific diagnosis

The International Classification of Headache Disorders, 2nd Edition: Application to Practice. Jes Olesen. Functional Neurology 2005; 20(2): 61-68

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Clinical practice Diagnosis for each headache type they have experienced within

the past year

Diagnoses should be listed in their order of importance to the patient

Provision is made for probable diagnoses headache types that are missing a single diagnostic feature

do not fulfil the full criteria for another headache

The International Classification of Headache Disorders, 2nd Edition: Application to Practice. Jes Olesen. Functional Neurology 2005; 20(2): 61-68

Page 10: International classification of headache disorders  changes in ichd2

Primary headache- diagnosis of exclusion the history, physical and neurological examinations do not

suggest a secondary disorder

a secondary disorder is suggested, but ruled out by appropriate investigations

a secondary disorder is present, but the primary headache attacks did not occur for the first time in close temporal relation to the causative disorder

The International Classification of Headache Disorders, 2nd Edition: Application to Practice. Jes Olesen. Functional Neurology 2005; 20(2): 61-68

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Secondary headache diagnoses new kind of headache for the first time in close temporal relation

to another disorder known to cause headache

headache is attributed to that disorder

Diagnosis of secondary headache in a patient with a pre-existing primary headache

it occurs in very close temporal relation to the potentially causative disorder

exacerbation of the headache is marked (or differs from the primary disorder)

The International Classification of Headache Disorders, 2nd Edition: Application to Practice. Jes Olesen. Functional Neurology 2005; 20(2): 61-68

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the evidence that the potentially causative disorder can cause headaches is strong

there is improvement or disappearance of headache after relief from the causative disorder

The International Classification of Headache Disorders, 2nd Edition: Application to Practice. Jes Olesen. Functional Neurology 2005; 20(2): 61-68

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LIMITATIONS/ CRITISISMS Classification criteria are too detailed and impractical for use in

daily practice

Addresses individual headache attacks only

provides a snapshot of the situation at a given moment

does not take into account the natural history of the headache or the spectrum of headache in the person

1. The “IHS” Classification (1988, 2004) – Contributions, Limitations and Suggestions. K Ravishankar. SUPPLEMENT OF JAPI • APRIL 2010 • VOL. 58 7

2. Headache classification: criticism and suggestions. G.C. Manzoni , P. Torelli. Neurol Sci (2004) 25:S67–S69

3. Headache & Related Disorders. Debashish Chowdhury, Meena Gupta, Geeta A Khwaja, Amit Batla. Chpt r1. Shashikant S Seshia

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Ignores diagnostic elements that may be very important and significant

family history age at onset recurrence patterns of attacks clinical course in relation to reproductive events in women of

childbearing age lifestyle and co morbidity

( requirement of a multi-axial classification system)

1. The “IHS” Classification (1988, 2004) – Contributions, Limitations and Suggestions. K Ravishankar. SUPPLEMENT OF JAPI • APRIL 2010 • VOL. 58 7

2. Headache classification: criticism and suggestions. G.C. Manzoni , P. Torelli. Neurol Sci (2004) 25:S67–S69

3. Headache & Related Disorders. Debashish Chowdhury, Meena Gupta, Geeta A Khwaja, Amit Batla. Chpt r1. Shashikant S Seshia

Page 15: International classification of headache disorders  changes in ichd2

Chronic migraine- criteria not representative of those migraine forms that over the years evolve to a daily chronic course

Interpretation of the relationship between chronic migraine and symptomatic drug overuse headache that seems too complicated and hardly applicable in practice

SUNCT - doubts are raised by its inclusion in Group 3 alongside cluster headache instead of Group 13 (cranial neuralgias and central causes of facial pain) alongside trigeminal neuralgia

1. The “IHS” Classification (1988, 2004) – Contributions, Limitations and Suggestions. K Ravishankar. SUPPLEMENT OF JAPI • APRIL 2010 • VOL. 58 7

2. Headache classification: criticism and suggestions. G.C. Manzoni , P. Torelli. Neurol Sci (2004) 25:S67–S69

3. Headache & Related Disorders. Debashish Chowdhury, Meena Gupta, Geeta A Khwaja, Amit Batla. Chpt r1. Shashikant S Seshia

Page 16: International classification of headache disorders  changes in ichd2

Cluster headache- failure to make the distinction between chronic from the onset and cluster headache evolved from episodic

New daily persistent headache (NDPH)- Group 4 of other primary headaches, lack of evidence in the literature to support its existence as a separate clinical entity, more appropriate to include NDPH in the Appendix to ICHD-II, until further research helps clarify its still undefined clinical picture

1. The “IHS” Classification (1988, 2004) – Contributions, Limitations and Suggestions. K Ravishankar. SUPPLEMENT OF JAPI • APRIL 2010 • VOL. 58 7

2. Headache classification: criticism and suggestions. G.C. Manzoni , P. Torelli. Neurol Sci (2004) 25:S67–S69

3. Headache & Related Disorders. Debashish Chowdhury, Meena Gupta, Geeta A Khwaja, Amit Batla. Chpt r1. Shashikant S Seshia

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PROPOSALS FOR ICHD III

Chronic migraine will move from the appendix into the main body of the classification

Simplification of the classification of migraine with aura

Introduce so-called ‘‘specifiers’’ in the migraine chapter, treatment-responsive and treatment refractory migraine

Jes Olesen. New plans for headache classification: ICHD-3. Cephalalgia 2011 31: 4

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Substantial changes, Other Primary Headaches, in response to important nosographic studies of some of these disorders

Extensive changes will be made regarding the secondary headaches, contrary to the existing criteria, the diagnosis of a secondary headache before it is treated

Already-published criteria for medication overuse headache into the main body of the classification

Jes Olesen. New plans for headache classification: ICHD-3. Cephalalgia 2011 31: 4

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CONCLUSION

Contributed positively to progress in the headache field

Present classification does have certain drawbacks

Feedback, opinions and arguments - more complete and practically relevant future editions of the Classification

A shorter, more portable classification which satisfies clinicians and researchers alike is the need of the hour

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THANK YOU