1.0 Migraine.
1.1 Migraine without aura.
A. At least 5 attacks ful“lling B...D.
B. Headache attacks lasting 4...72 hours (2...48 hours for children below
age 15), untreated or unsuccessfully treated.
C. Headache has at least two of the following characteristics:
- Unilateral location.
- Pulsating quality.
- Moderate or severe intensity (inhibits or prohibits daily activities).
- Aggravation by walking stairs or similar routine physical activity.
D. During headache at least one of the following: - Nausea and/or vomiting.
- Photophobia and phonophobia.
E. At least one of the following: - History, physical, and neurological examinations do not suggest
one of the disorders listed in groups 5...11 (see Table 11.2). - History and/or physical, and/or neurological examinations do
suggest such disorder, but is ruled out by appropriate
investigations. - Such disorder is present, but migraine attacks do not occur for the
“rst time in close temporal relation to the disorder.
1.2 Migraine with aura.
A. At least two attacks ful“lling B.
B. At least three of the following four characteristics: - One or more fully reversible aura symptoms indicating focal
cerebral cortical and/or brain stem dysfunction. - At least one aura symptom develops gradually over more than
4 minutes or two or more symptoms occur in succession. - No aura symptom lasts more than 60 minutes. If more than one
aura symptom is present, accepted duration is proportionally
increased. - Headache follows with a free interval of less than 60 minutes. It
may also begin before or simultaneously with the aura.
C. Same as Migraine without aura, criteria E.
2.0 Tension-Type.
2.1 Episodic tension-type headache.
A. At least 10 previous headache episodes ful“lling criteria B...D.
Number of days with such headache 180/year ( 15/month).
B. Headache lasting from 30 minutes to 7 days.
C. At least two of the following pain characteristics: - Pressing/tightening (nonpulsating) quality.
- Mild or moderate intensity (may inhibit, but does not prohibit
activities). - Bilateral location.
- No aggravation by walking stairs or similar routine physical
activity.
D. Both of the following: - No nausea or vomiting (anorexia may occur).
- Photophobia and phonophobia are absent, or one but not the other
is present.
E. Same as Migraine without aura, criteria E.
2.1.1 Episodic tension-type headache associated with disorder of
pericranial muscles.
A. Ful“lls criteria for 2.1.
B. At least one of the following: - Increased tenderness of pericranial muscles demonstrated by
manual palpation or pressure algometer. - Increased EMG level of pericranial muscles at rest or during
physiological tests.
2.1.2 Episodic tension-type headache unassociated with disorder of
pericranial muscles.
A. Ful“lls criteria for 2.1.
B. No increased tenderness of pericranial muscles. If studied,
EMG of pericranial muscles shows normal levels of activity.
2.2 Chronic tension-type headache.
A. Average headache frequency 15 days/month (180 days/year) for
6 months ful“lling criteria B...D listed below.
B. Same as criteria B, episodic tension-type headache.
C. Both of the following:- No vomiting.
- No more than one of the following: nausea, photophobia, or
phonophobia.
D. Same as Migraine without aura, criteria E.
2.2.1 Chronic tension-type headache associated with disorder of
pericranial muscles.
A. Ful“lls criteria for 2.2.
B. Same as criteria B for 2.1.1.
2.2.2 Chronic tension-type headache unassociated with disorder of
pericranial muscles.
A. Ful“lls criteria for 2.2.
B. Same as criteria B for 2.1.2.
3.1 Cluster headache.
A. At least “ve attacks ful“lling B...D.
B. Severe unilateral orbital, supraorbital, and/or temporal pain lasting
15...180 minutes untreated.
C. Headache is associated with at least one of the following signs which
have to be present on the pain-side: - Conjunctival injection.
- Lacrimation.
- Nasal congestion.
- Rhinorrhea.
- Forehead and facial sweating.
- Miosis.
- Ptosis.
- Eyelid edema.
D. Frequency of attacks from one every other day to eight per day.
E. Same as criteria E for 1.1.
5.2 Chronic posttraumatic headache
5.2.1 With signi“cant head trauma and/or con“rmatory signs.
A. Signi“cance of head trauma documented by at least one of the
following: - Loss of consciousness.
- Posttraumatic amnesia lasting more than 10 minutes.
- At least two of the following exhibit relevant abnormality:
clinical neurological examination, x-ray of skull,
neuroimaging, evoked potentials, spinal ”uid examination,
vestibular function test, neuropsychological testing.
B. Headache occurs less than 14 days after regaining conscious-
ness (or after trauma, if there has been no loss of conscious-
ness). Headache continues more than 8 weeks after regaining
consciousness (or after trauma, if there has been no loss of
consciousness).
5.2.2 With minor head trauma and no con“rmatory signs.
A. Head trauma that does not satisfy 5.2.1.A.
B. Headache occurs less than 14 days after injury.
C. Headache continues more than 8 weeks after injury.
8.2 Headache induced by chronic substance use or exposure.
A. Occurs after daily doses of a substance for ≥3 months.
B. A certain required minimum dose should be indicated.
C. Headache is chronic (15 days or more a month).
D. Headache disappears within 1 month after withdrawal of the
substance.
8.2.1 Ergotamine-induced headache.
A. Is preceded by daily ergotamine intake (oral ≥2 mg, rectal
≥1 mg).
B. Is diffuse, pulsating, or distinguished from migraine by absent
attack patterns and/or absent associated symptoms.
8.2.2 Analgesics abuse headache.
A. One or more of the following:
1.50 g aspirin a month or equivalent of other mild
analgesics.
2.100 tablets a month of analgesics combined with
barbiturates or other nonnarcotic compounds. - One or more narcotic analgesics.
TABLE 11.3 Headache Diagnostic Criteria
Source:From the International Headache Society (IHS) Headache Classi“cation Committee (1988). The Norwegian University Press.
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