New appendix criteria open for a broader concept of chronic migraine

J. Olesen, M. G. Bousser, H. C. Diener, D. Dodick, M. First, P. J. Goadsby, H. Göbel, M. J.A. Lainez, J. W. Lance, R. B. Lipton, G. Nappi, F. Sakai, J. Schoenen, S. D. Silberstein, T. J. Steiner

Research output: Contribution to journalArticlepeer-review

765 Scopus citations


After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.

Original languageEnglish (US)
Pages (from-to)742-746
Number of pages5
Issue number6
StatePublished - Jun 2006


  • Argot alkaloids
  • Disease classification
  • Drug dependency
  • Migraine
  • Opioids
  • Primary headaches
  • Triptans

ASJC Scopus subject areas

  • Clinical Neurology


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